KENTUCKY DIVISION OF EMERGENCY MANAGEMENT
RESCUE AID FUND MINIMUM EQUIPMENT PROJECT APPLICATION 	
PART I - RESCUE SQUAD INFORMATION	
1.  Name of the Squad:	
2.  Chief Rescue Officer of the Squad:	
3.  Mailing Address of the Squad:	
4.  City:                                                                          County:                                                               Zip:	
5.  Business Phone:  (       )                                         6.  Kentucky Division of Emergency Management Area #:	
7.  Identify the squad’s primary geographic service area:	
8.  Rescue squad has authorization to operate in the jurisdiction been authorized by the chief elected official?  (Ref KRS   
     39F.020(1)		
9.  Does the rescue squad have written bylaws and standard operating procedures as required by KRS 39F.120 (1)(2)?		
10.  Does the rescue squad have a current affiliation agreement with the local Emergency Management Agency as
       required by KRS 39F.120(9)? 		
11.  Is the rescue squad incorporated within another emergency service agency and, if so, are the squad members  
       available for and capable of performing rescue services not incidental to their primary mission?  (Ref KRS   
       39F.120(11))		
12.  Does the squad charge for its services?		
13.  What is the population in the squad’s service area?		
14.  What is the population of the county?		
15.  How many rescue missions did the squad respond to during  the past fiscal year (July 1 thru June 30)?		
16.  How many total man-hours of rescue training were completed by squad members during the past fiscal year?		
17.  What is the average response time, in minutes, to the most outer limits of the squad’s service area?		
18.  What is the average operational budget for the squad for the past four (4) years?		
19.  What is the squad’s equipment budget for this year?		
20.  How much funding is available locally to assist with the purchase of the equipment being requested?		
21.  Would the squad be willing to accept partial funding for the equipment being requested?		
22.  Indicate what percentage of funding would be acceptable to assist with the purchase of the equipment being 
       requested?		
23.  The rescue squad has the following missions identified in their bylaws, standard operating procedures and affiliation agreement: 	
GENERAL RESCUE SQUADS (Check one or more) 	SPECIALIZED RESCUE SQUADS (Check one or more)	
Light Duty Rescue   		Cave rescue		
Extrication           		Search utilizing dogs for lost, trapped or missing persons		
Water Rescue and Recovery not utilizing divers		Search for lost, trapped or missing persons utilizing aircraft		
Search for lost, trapped or missing persons		Water rescue and recovery utilizing divers

           Number of Certified Divers		
Low angle rescue and recovery			#	
High angle rescue and recovery				

INSTRUCTIONS

	Part I completed by Rescue Squad Chief
	Part II completed by Local EM Director
	Part III completed by Area Manager
	Part IV completed by State SAR Coordinator
	Part V completed by Rescue Review Committee

PAGE 1 INSTRUCTIONS

1.	Enter the name of the rescue squad.
2.	Enter name of the rescue squad chief.
3.	Enter the street address of the rescue squad (mailing address).
4.	Enter the city, county and zip of the mailing address.
5.	Enter phone number.
6.	Enter the KyEM Area where the rescue squad is located.
7.	Enter the geographic area of responsibility of the rescue squad.
8.	Answer yes or no.
9.	Answer yes or no.
10.	Answer yes or no and include the date of expiration of the current agreement.
11.	Answer yes or no.
12.	Answer yes or no.
13.	Enter population of area served.
14.	Enter population of the county.
15.	Enter number of rescue missions conducted from Jul 1 thru Jun 30.
16.	Enter number of man hours of training conducted during the year.
17.	Enter the average response time to the outer limits of the service area.
18.	Enter the average operational budget of the rescue squad.
19.	Enter the rescue squad equipment budget for this year.
20.	Enter the amount of funding available locally to assist in the purchase of the equipment being requested.
21.	Answer yes or no.
22.	Enter the percentage of grant funding that would be acceptable to assistance in the purchase of the equipment being requested.
23.	Place a check in the box indicating the type(s) of rescue missions conducted by the squad.  Types of missions must be included in the squads bylaws and affiliation agreement.  

PAGE 4 INSTRUCTIONS

	Column 1 – PRIORITY – Indicates the priority assigned to each type of equipment being requested.
	Column 2 – QUANTITY – Enter the number of items being requested.  This number cannot exceed the 
				authorized number of pieces of equipment as listed on the Minimum Equipment List.
	Column 3 – ITEM – Describe the minimum equipment being requested.
	Column 4 – UNIT PRICE – Enter the unit price of the equipment being requested.
	Column 5 – N/R – Indicate if this is new equipment or replacement equipment.
	Column 6 – TOTAL COST – Enter the total cost of the item being requested.  At the bottom of the TOTAL 
				COST column enter the total amount of rescue aid funds being requested.
	Column 7 – AMOUNT APPROVED – used by the State SAR Coordinator.

KENTUCKY DIVISION OF EMERGENCY MANAGEMENT
RESCUE AID FUND MINIMUM EQUIPMENT PROJECT APPLICATION	
GENERAL RESCUE SQUAD MINIMUM EQUIPMENT REQUIREMENTS	
General Rescue Squads may request funding for the minimum new or replacement equipment listed in 106 KAR 1:350, Section 2.	
WATER RESCUE AND RECOVERY SQUAD MINIMUM EQUIPMENT REQUIREMENTS	
Rescue squads specializing in water rescue and recovery not utilizing divers shall possess the following equipment before requesting funding of additional minimum water recovery equipment: 	
     One (1) vehicle dedicated to water 
      Rescue and recovery	One (1) 16’ jon boat (16’ or larger)
One (1) boat motor, minimum 15 HP	One (1) boat trailer, Two (2) boat oars
	
If your squad has the above equipment, you are eligible to apply for the minimum water rescue and recovery “New or replacement equipment” or “Replacement equipment only” listed in 106 KAR 1:350, Section 3. 	
DIVE RESCUE AND RECOVERY SQUAD MINIMUM EQUIPMENT REQUIREMENTS	

►►►ATTACH ALL COPIES OF DIVE CERTIFICATES OF CERTIFIED DIVERS TO THIS APPLICATION◄◄◄
	
Rescue squads specializing in water rescue and recovery utilizing divers shall possess the minimum equipment established for a water rescue and recovery squad and the following equipment before requesting funding of additional minimum dive rescue and recovery equipment:	
Two (2) extra tanks per certified diver
 One (1) dry suit per certified diver	Three (3) dive flags
	One (1) underwater radio communications equipment per diver	
If your squad has the above equipment, you are eligible to apply for the minimum dive rescue and recovery “New or replacement equipment” or “Replacement equipment only” listed in 106 KAR 1:350, Section 4.
  	
HIGH ANGLE AND/OR CAVE RESCUE SQUAD MINIMUM EQUIPMENT REQUIREMENTS	
Rescue squads specializing in high angle or cave rescue shall possess the following equipment before requesting funding of additional minimum high angle or cave rescue equipment: 	
One (1) vehicle dedicated to high      angle or cave rescue	One (1) Stokes basket litter or equivalent
One (1) 200’x 7/16” static kernmantle rope
	Four (4) large “D” locking carabiners
One (1) figure “8” descender
Four (4) 15’x1” nylon webbing	
If your squad has the above equipment, you are eligible to apply for the minimum high angle or cave rescue “New or replacement equipment” or “Replacement equipment only” listed in 106 KAR 1:350, Section 5.
	
SEARCH DOG RESCUE SQUAD 	

Rescue squads specializing in searching for lost, trapped or missing persons utilizing dogs shall be eligible to apply for the search dog rescue squad minimum “New or replacement equipment” listed in 106 KAR 1:350, Section 6.

KENTUCKY DIVISION OF EMERGENCY MANAGEMENT
RESCUE AID FUND MINIMUM EQUIPMENT PROJECT APPLICATION	
FUNDING REQUEST	
PRIORITY	QUANTITY	ITEM	UNIT
PRICE	*N/R	TOTAL COST	AMOUNT APPROVED
(Cost - % acceptable)	
1							
2							
3							
4							
5							
6							
7							
8							
9							
10							
11							
12							
13							
14							
15							
16							
17							
18							
19							
20							
21							
22							
23							
24							
TOTALS			
*  N/R – INDICATE IF THE EQUIPMENT IS NEW OR REPLACEMENT.
KENTUCKY DIVISION OF EMERGENCY MANAGEMENT
RESCUE AID FUND MINIMUM EQUIPMENT PROJECT APPLICATION	
JUSTIFICATION STATEMENT	

PROVIDE A WRITTEN EXPLANATION OF THE NEED FOR THE MINIMUM EQUIPMENT BEING REQUESTED. 

IF THE RESCUE SQUAD IS REQUESTING FUNDS FOR MINIMUM EQUIPMENT OVER THE NUMBER REQUIRED ON THE MINIMUM EQUIPMENT LIST THAT EQUIPMENT IS CONSIDERED OPTIONAL EQUIPMENT AND IS NOT ELIGIBLE UNDER THIS MINIMUM EQUIPMENT GRANT CYCLE.

If an item the squad is requesting costs in excess of $5,000.00, attach a bid quote from the company or representative that identifies the cost, delivery schedule and maintenance provisions.

                           (BE AS EXPLICIT AS POSSIBLE WHEN DEFINING THE NEED FOR THIS EQUIPMENT.  USE ADDITIONAL SHEETS AS NECESSARY)

	

	

	

	

	

	

	
CHIEF RESCUE OFFICER SIGNATURE: ________________________________ DATE SIGNED: _________________	

CERTIFICATION AND COMPLIANCE AGREEMENT	

I _______________________________________(Chief Rescue Officer’s Name) certify, under penalties of perjury, I have examined this document, including all supporting documents, and to the best of my knowledge, it is true, correct, and complete.  

I further agree to comply with the statutes and regulations under which rescue aid funds are awarded; to use all funds as specified on this application; to purchase only those items approved by the Division of Emergency Management Director; and to make all equipment available for inspection by authorized state and local officials upon proper request.

CHIEF RESCUE OFFICER SIGNATURE: ___________________________________ DATE SIGNED: ____________________
	
Attach the following documents to the application:

1.	Current RESCUE SQUAD CUMULATIVE EQUIPMENT INVENTORY, KyEM Form 465
2.	Current SEARCH AND RESCUE SQUAD QUARTERLY ACTIVE MEMBERSHIP LIST, KyEM Form 430

KENTUCKY DIVISION OF EMERGENCY MANAGEMENT
RESCUE AID FUND MINIMUM EQUIPMENT PROJECT APPLICATION	
PART II - LOCAL EMERGENCY MANAGEMENT DIRECTOR’S REVIEW/COMMENTS/RECOMMENDATIONS	

ALL QUARTERLY TRAINING & INCIDENT REPORTS ARE ON FILE IN MY OFFICE FOR THE PREVIOUS STATE FISCAL YEAR.	

CURRENT KyEM FORM 430 AND KyEM FORM 465 ARE ATTACHED.	

ALL REQUIRED INFORMATION HAS BEEN INCLUDED ON THE APPLICATION?

# OF COUNTY RESCUE SQUADS SUBMITTING APPLICATION FOR THIS GRANT CYCLE.	
#	

PRIORITY ASSIGNED TO THIS APPLICATION ( 1, 2, 3, ……)?	
#	

THIS APPLICATION IS FOR MINIMUM, NEW OR REPLACEMENT EQUIPMENT ONLY?	

CURRENT AFFILIATION AGREEMENT (ENTER DATE)?	

CURRENT MEMBERSHIP LIST?	

CURRENT BYLAWS?	

CURRENT STANDARD OPERATING PROCEDURES?	

TOTAL RESCUE MISSIONS   	

TOTAL TRAINING HOURS ________	

EQUIPMENT REQUESTED (ENTER NEW OR REPLACEMENT):	

I HAVE REVIEWED THIS APPLICATION IN IT’S ENTIRETY AND HAVE ATTACHED AN UPDATED RESCUE SQUAD CUMULATIVE EQUIPMENT INVENTORY AS REQUIRED BY ADMINISTRATIVE REGULATION.  I HAVE THE FOLLOWING COMMENTS/RECOMMENDATIONS:  (IF MORE THAN ONE RESCUE AID FUND APPLICATION IS BEING SUBMITTED FROM A LOCAL JURISDICTION FOR A REVIEW PERIOD, A LOCAL EM DIRECTOR MUST INCLUDE COMMENTS/RECOMMENDATIONS INDICATING WHICH APPLICATION IS TO HAVE FIRST PRIORITY FOR FUNDING). 

	

	

LOCAL EM DIRECTOR’S SIGNATURE: ____________________________________________________ DATE REVIEWED: ___________________

PART III - KyEM AREA MANAGER’S COMMENTS/RECOMMENDATIONS	

ALL QUARTERLY TRAINING & INCIDENT REPORTS ARE ON FILE IN MY OFFICE FOR THE PREVIOUS STATE FISCAL YEAR.	

AFFILIATION AGREEMENT IS CURRENT.	

ALL REQUIRED INFORMATION HAS BEEN INCLUDED ON THE APPLICATIONS?	

THIS APPLICATION IS FOR MINIMUM, NEW OR REPLACEMENT EQUIPMENT ONLY?	

Application Number:  (M-YYYY-Area #-county###-Priority ##; Example: M-2005-07-008-01)	

	

	

	

	

	

	

I HAVE REVIEWED THIS APPLICATION FOR COMPLIANCE WITH STATUTES, REGULATIONS, POLICIES AND PROCEDURES AND OFFER THE FOLLOWING COMMENTS/RECOMMENDATIONS:

	

	

	

AREA MANAGER’S SIGNATURE: _________________________________________________________ DATE REVIEWED: ___________________

PART IV - KyEM SAR COORDINATOR REVIEW/COMMENTS/RECOMMENDATIONS	

Application #:  _________________________________________________________________________

County:  ______________________           KyEM Area: __________

Rescue Squad Name:  __________________________________________________________________

# of Squads in the County: _________                # of Squads from County applying for grant: ___________

Local EM Director priority for this application:  _________

Total Amount Requested $ _____________        % of funding acceptable: ______%       

RECOMMEND FUNDING THE FOLLOWING ITEMS	

ITEM	
N/R	
UNIT COST	
% Funded	
TOTAL FUNDED	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

	

COMMENTS:  

	

STATE SAR COORDINATURE SIGNATURE:_______________________________________________ DATE REVIEWED: ___________________

PART V - KyEM RESCUE REVIEW COMMITTEE RECOMMENDATIONS	

Application #:  _________________________________________________________________________

Date Reviewed: _______________

Review Committee Recommendation:       Approval ______  Partial Approval ________  Denial _______

RECOMMEND FUNDING THE FOLLOWING ITEMS	
ITEM	N/R	UNIT COST	TOTAL COST	% Funded	AMOUNT AWARDED	

						

						

Comments/Justification: 

State SAR Coordinator Signature: __________________________________________  Date: ________________