Form FEMA Form 080-0-2b FEMA Form 080-0-2b Activity specific Question for AFG Operations and Safety

2012 Assistance to Firefighters Grant Program Application - Fire

Firefighting Vehicle Program

Please provide the following information about the vehicle you want funded. If your organization is applying for equipment and a vehicle, you must fill out a separate application for the equipment. If your organization is requesting multiple vehicles, then you must complete separate sheets for the Vehicle Details, Additional Funding, and Narrative of each vehicle you are requesting.

Note: Fields marked with an * are required.

Vehicle Details
* 1. What type or class of vehicle will you use the grant funds to purchase? (select one from list of Firefighting Vehicle Types on page 47)
Please provide further description of the item selected above:
* 2. Cost (whole dollar amounts only)		$
* 3. Is the vehicle you propose to buy a refurbished, used or new response vehicle to meet current standards?		○ New (never owned before) ○ Refurbished (compliant to current standards) ○ Refurbished (compliant to the year of manufacturing) ○ Used (compliant to the year of manufacturing)
* 4. What is the age of the vehicle being replaced?	○ N/A ○ less than 1 year ○ 1 year ○ 2 years ○ 3 years ○ 4 years		○ 5 years ○ 6 years ○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years	○ 12 years ○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years		○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 25 years	○ 26 years ○ 27 years ○ 28 years ○ 29 years ○ 30 years ○ More than 30 years
* 5. What is the newest (age) vehicle you currently own in the class you are purchasing?	○ N/A ○ less than 1 year ○ 1 year ○ 2 years ○ 3 years ○ 4 years		○ 5 years ○ 6 years ○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years	○ 12 years ○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years		○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 25 years	○ 26 years ○ 27 years ○ 28 years ○ 29 years ○ 30 years ○ More than 30 years
* 6. How old is the oldest (age) vehicle you own in the class you are purchasing?	○ N/A ○ less than 1 year ○ 1 year ○ 2 years ○ 3 years ○ 4 years		○ 5 years ○ 6 years ○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years	○ 12 years ○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years		○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 25 years	○ 26 years ○ 27 years ○ 28 years ○ 29 years ○ 30 years ○ More than 30 years
* 7. What is the average age of all vehicles in your fleet?	○ N/A ○ less than 1 year ○ 1 year ○ 2 years ○ 3 years ○ 4 years		○ 5 years ○ 6 years ○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years	○ 12 years ○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years		○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 25 years	○ 26 years ○ 27 years ○ 28 years ○ 29 years ○ 30 years ○ More than 30 years

(continued from previous page)

*8. Do you have a driver-training program equivalent to national or NFPA standards?		○ Yes ○ No
If you answered No, will you develop one prior to receipt of the vehicle per the program guidance?		○ Yes ○ No
*Are you requesting funding for training specific to the vehicle acquisition? (Funding for requested training should be requested in the Firefighting Vehicle Additional Funding section on page 49).		○ Yes ○ No
If you are not requesting funding, will you obtain the appropriate training through other sources?		○ Yes ○ No
*9. Is the vehicle you propose to buy:	○ First time purchase for increased risk (do not currently own in this class) ○ Replacement of an existing apparatus ○ Addition to the fleet
*10. Is the vehicle you are replacing a converted vehicle not originally designed for its current use?		○ Yes ○ No ○N/A - First Time Purchase
*11. Does the vehicle you are replacing have an open cab configuration?		○ Yes ○ No ○N/A - First Time Purchase
*12. If awarded, will you permanently remove this substandard vehicle from service?		○ Yes ○ No ○N/A - First Time Purchase
If you are removing a vehicle from service, describe the vehicle you plan to remove in the space provided. Please enter the type, year, model.
Please enter the VIN (Vehicle Identification Number) for the vehicle you are requesting to replace:
*13. How long have you owned the vehicle you are replacing?		_____________ Years (whole number only) ○N/A
*14. If you are removing a vehicle from service, what is the number of calls that vehicle responded to during 2011 (documented through vehicle or dispatch logs)? (whole number only)		_____________ ○N/A
*15. If awarded, will you develop and/or enforce standard operating policies/procedures that require: 1) all occupants to use seatbelts, 2) all drivers of the grantee’s apparatus must adhere to all traffic signs, signals and state traffic regulations.		○ Yes ○ No
*16. Will this vehicle be used for automatic and/or mutual aid?		○ Automatic Aid ○ Mutual Aid ○ Both ○ None
*17. What percentage of your annual budget goes to vehicle replacement?		(0-100%)

Firefighting Vehicle Types (select one for Vehicle Details Q1)

Engine
Pumper/Engine (750 gpm or more and holds a minimum of 300 gallons or more)
Pumper with CAFS
Type I Engine Urban Interface
Ambulance
Ambulance
Tanker
Tanker/Tender (750 gpm or less and holds a minimum of 1000 gallons or more)
Brush/Attack
Brush Truck
Patrol Unit (Pick up w/Skid Unit)
Mini-Pumper
Type II Engine
Type III Engine
Type IV Engine
Type V Engine
Type VI Engine
Aerial
Aerial Ladder Truck
Telescoping
Articulating
Ladder Towers
Platforms
Tiller Ladder Truck
Quint
Rescue (non-transport)
Rescue (Light, Medium, Heavy)	Technical Rescue Vehicle
Other/Specialized Vehicles
ARFF (Aircraft Rescue Firefighting)	Hazardous Materials Unit
Command/Mobile Communications Vehicle	Rehab Unit
Air/Light Unit	Fire Rescue/Boat
Foam truck	Highway Safety Unit

Firefighting Vehicle Inventory

Please provide the following information.

If you have 15 emergency response vehicles or less, list all of your Engines/Pumpers, Tankers, Aerials, Brush and Rescue Vehicles. List all vehicles providing the type, the age, the pump capacity (GPM) if applicable, the carrying capacity (gallons) if applicable.

Vehicle Type (possible terms: Engine or Pumper, Ambulance, Tanker, Aerial Apparatus, Brush/Quick Attack, Rescue Vehicles, or Additional Vehicles)		Age	GPM	Gallons
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

If you have more than 15 emergency response vehicles - other than those categorized as “Other”, please provide the oldest, newest, and average age for each type of vehicle.

Type or Class	Quantity	Oldest (age)	Newest (age)	Average age
Engines (or Pumpers)
Ambulance
Tankers
Aerial Apparatus
Brush/Quick Attack
Rescue Vehicles
Additional Vehicles

Firefighting Vehicle - Additional Funding (optional unless you’re applying for Training funds)

Enter any additional funding for your grant in the space provided below. You will need to explain the additional costs. The costs added in this section must show a direct relationship to the costs already included in your Request Details. Please note that this section is optional. Definitions can be found on page 6 of this application.

Additional Funding
a. Personnel	$
b. Fringe Benefits	$
c. Travel	$
d. Equipment	$
e. Supplies	$
f. Contractual	$
g. Construction	$
h. Other	$
i. Indirect Charges	$
j. State Taxes	$
Explanation (Attach an additional sheet if necessary)

Firefighting Vehicle Narrative Statement

The program narratives should provide all the information necessary for you to justify your needs and for the program office to make an award decision. In the program narrative sections, please explain your needs and how the grants funds will be utilized. A panel of your peers will review the narratives below and the financial need narrative in the Applicant Characteristics II section as part of their evaluation of your entire grant application.

Please ensure that your narrative clearly addresses each of the following areas to the best of your ability. Follow the sequence and specifically address each of the following topics:

• Section #1 Project Description: What are you requesting funding for, including budget descriptions of the major budget items, i.e., personnel, equipment, contracts, etc?

• Section #2 Cost/Benefit: What benefits will your department or community realize if the project described is funded? Provide justification for the budget items relating to the cost of the requested items.

• Section #3 Statement of Effect: How would this award affect the daily operations of your department and how would this award affect your department’s ability to protect lives and property in your community?

• Section #4 Additional Information: In the space provided below, include details regarding your organization’s request not covered in any other section.

Your narrative should be detailed but concise. You may either type your project narrative in the space provided below; or create the text in your word processing system then copy it into the space provided below. Images are not allowed, attach additional pages if necessary.

Note: Fields marked with an * are required.

Project Description

* Section #1 Project Description: In the space provided below include clear and concise details regarding your organization’s project’s description and budget. This includes providing local statistics to justify the needs of your department and a detailed plan for how your department will implement the proposed project. Further, please describe what you are requesting funding for including budget descriptions of the major budget items, i.e., personnel, equipment, contracts, etc.

* Section #2 Cost/Benefit: In the space provided below please explain, as clearly as possible, what will be the benefits your department or your community will realize if the project described is funded (i.e. anticipated savings and/or efficiencies)? Is there a high benefit for the cost incurred? Are the costs reasonable? Provide justification for the budget items relating to the cost of the requested items.

* Section #3 Statement of Effect: How would this award affect the daily operations of your department (i.e., describe how frequently the equipment will be used or what the benefits will provide the personnel in your department)? How would this award affect your department’s ability to protect lives and property in your community?

* Section #4 In the space provided below include details regarding your organization’s request not covered in any other section.

Please continue to page 112 and Total Budget.

EMS Vehicle Program

Please provide the following information about the vehicle you want funded. If your organization is requesting multiple vehicles, then you must complete separate sheets for the Vehicle Details, Additional Funding, and Narrative of each vehicle you are requesting. If your organization is a fire department, go to page 45.

Note: Fields marked with an * are required.

EMS Vehicle Details
* 1. What type or class of vehicle will you use the grant funds to purchase?			○ Ambulance ○ Non-Transport
* Please provide further description of the item selected above.
* 2. Cost (whole dollar amounts only)			$
* 3. Is the vehicle you propose to buy a refurbished, used or new response vehicle to meet current standards?			○ New (never owned before) ○ Refurbished (compliant to current standards) ○ Refurbished (compliant to the year of manufacturing) ○ Used (compliant to the year of manufacturing)
* 4. What is the age of the vehicle being replaced?	○ N/A ○ less than 1 year ○ 1 year ○ 2 years ○ 3 years ○ 4 years	○ 5 years ○ 6 years ○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years		○ 12 years ○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years	○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 25 years	○ 26 years ○ 27 years ○ 28 years ○ 29 years ○ 30 years ○ More than 30 years
* 5. What is the newest (age) vehicle you currently own in the class you are purchasing?	○ N/A ○ less than 1 year ○ 1 year ○ 2 years ○ 3 years ○ 4 years	○ 5 years ○ 6 years ○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years		○ 12 years ○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years	○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 25 years	○ 26 years ○ 27 years ○ 28 years ○ 29 years ○ 30 years ○ More than 30 years
* 6. How old is the oldest (age) vehicle you own in the class you are purchasing?	○ N/A ○ less than 1 year ○ 1 year ○ 2 years ○ 3 years ○ 4 years	○ 5 years ○ 6 years ○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years		○ 12 years ○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years	○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 25 years	○ 26 years ○ 27 years ○ 28 years ○ 29 years ○ 30 years ○ More than 30 years
* 7. What is the average age of all vehicles in your fleet?	○ N/A ○ less than 1 year ○ 1 year ○ 2 years ○ 3 years ○ 4 years	○ 5 years ○ 6 years ○ 7 years ○ 8 years ○ 9 years ○ 10 years ○ 11 years		○ 12 years ○ 13 years ○ 14 years ○ 15 years ○ 16 years ○ 17 years ○ 18 years	○ 19 years ○ 20 years ○ 21 years ○ 22 years ○ 23 years ○ 24 years ○ 25 years	○ 26 years ○ 27 years ○ 28 years ○ 29 years ○ 30 years ○ More than 30 years

(continued from previous page)

*8. Do you have a formal driver-training program?		○ Yes ○ No
If you answered No, will you develop one prior to receipt of the vehicle per the program guidance?		○ Yes ○ No
*Are you requesting funding for training specific to the vehicle acquisition? Funding for Training must be included in the EMS Vehicle – Additional Funding section on page 84.		○ Yes ○ No
If you are not requesting funding, will you obtain the appropriate training through other sources?
*9. Is the vehicle you propose to buy:	○ First time purchase for new mission (do not currently own in this class) ○ Replacement of an existing apparatus ○ Addition to the fleet
*10 Is the vehicle you are replacing a converted vehicle not originally designed for its current use?	○ Yes ○ No ○N/A - First Time Purchase
*11. If awarded, will you permanently remove this substandard vehicle from service?	○ Yes ○ No
If you are removing a vehicle from service, describe the vehicle you plan to remove in the space provided. Please enter the type, year, and model.
Please enter the VIN (Vehicle Identification Number) for the vehicle you are requesting to replace:
*12. How long have you owned the vehicle you are replacing?	_____________ Years (whole number only) ○N/A
*13. If you are removing a vehicle from service, what is the number of calls that vehicle responded to during 2011 (documented through vehicle or dispatch logs)? (whole number only)			_______________ ○N/A
*14. If you are removing a vehicle from service, what is the mileage on the vehicle you plan to replace? (select one)	○ < 40,000 ○ 60,000 to 79,999 ○ 40,000 to 49,999 ○ 80,000 to 99,999 ○ 50,000 to 59,999 ○ > 100,000
*15. If awarded, will you develop and/or enforce standard operating policies/procedures that require: 1) all occupants to use seatbelts, 2) all drivers of the grantee’s apparatus must adhere to all traffic signs, signals and state traffic regulations.			○ Yes ○ No
*16. Will this vehicle be used for automatic and/or mutual aid?	○ Automatic Aid ○ Mutual Aid ○ Both ○ None
*17. What percentage of your annual budget goes to vehicle replacement?	(0-100%)

EMS Vehicle Inventory

Please provide the following information.

If you have 15 emergency response vehicles or less, list all vehicles providing the type, the age, and if the vehicle is used for patient transportation.

Vehicle Type (possible terms: Ambulance or Non-Transport)		Age	Is this vehicle used for transport?
1			○ Yes ○ No
2			○ Yes ○ No
3			○ Yes ○ No
4			○ Yes ○ No
5			○ Yes ○ No
6			○ Yes ○ No
7			○ Yes ○ No
8			○ Yes ○ No
9			○ Yes ○ No
10			○ Yes ○ No
11			○ Yes ○ No
12			○ Yes ○ No
13			○ Yes ○ No
14			○ Yes ○ No
15			○ Yes ○ No

If you have more than 15 emergency response vehicles, please provide the oldest, newest, and average age for each type of vehicle.

Type or Class	Quantity	Oldest (age)	Newest (age)	Average (age)
Ambulance
Non-Transport

EMS Vehicle - Additional Funding (optional unless you’re applying for Training funds)

Enter any additional funding for your grant in the space provided below. You will need to explain the additional costs. The costs added in this section must show a direct relationship to the costs already included in your Request Details. Please note that this section is optional. Definitions can be found on page 6 of this application.

Additional Funding
a. Personnel	$
b. Fringe Benefits	$
c. Travel	$
d. Equipment	$
e. Supplies	$
f. Contractual	$
g. Construction	$
h. Other	$
i. Indirect Charges	$
j. State Taxes	$
Explanation (Attach an additional sheet if necessary)

EMS Vehicle Narrative Statement

The program narratives should provide all the information necessary for you to justify your needs and for the program office to make an award decision. In the program narrative sections, please explain your needs and how the grants funds will be utilized. A panel of your peers will review the narratives below and the financial need narrative in the Applicant Characteristics II section as part of their evaluation of your entire grant application.

Please ensure that your narrative clearly addresses each of the following areas to the best of your ability. Follow the sequence and specifically address each of the following topics:

• Section #1 Project Description: What are you requesting funding for, including budget descriptions of the major budget items, i.e., personnel, equipment, contracts, etc?

• Section #2 Cost/Benefit: What benefits will your department or community realize if the project described is funded? Provide justification for the budget items relating to the cost of the requested items.

• Section #3 Statement of Effect: How would this award affect the daily operations of your department and how would this award affect your department’s ability to protect lives and property in your community?

• Section #4 Additional Information: In the space provided below, include details regarding your organization’s request not covered in any other section.

Your narrative should be detailed but concise. You may either type your project narrative in the space provided below; or create the text in your word processing system then copy it into the space provided below. Images are not allowed, attach additional pages if necessary.

Note: Fields marked with an * are required.

Project Description

* Section #1 Project Description: In the space provided below include clear and concise details regarding your organization’s project’s description and budget. This includes providing local statistics to justify the needs of your department and a detailed plan for how your department will implement the proposed project. Further, please describe what you are requesting funding for including budget descriptions of the major budget items, i.e., personnel, equipment, contracts, etc.

* Section #2 Cost/Benefit: In the space provided below please explain, as clearly as possible, what will be the benefits your department or your community will realize if the project described is funded (i.e. anticipated savings and/or efficiencies)? Is there a high benefit for the cost incurred? Are the costs reasonable? Provide justification for the budget items relating to the cost of the requested items.

* Section #3 Statement of Effect: How would this award affect the daily operations of your department (i.e., describe how frequently the equipment will be used or what the benefits will provide the personnel in your department)? How would this award affect your department’s ability to protect lives and property in your community?

* Section #4 In the space provided below include details regarding your organization’s request not covered in any other section.