Alice Quinday City of Russell Fire Department

Printed On: 17 May 2018 Requests of more than $5,000 1

SCBA EquipmentRequests of more than $5,000

City of Russell Fire DepartmentMr. Shane Preston 815 N. Maple StP.O. Box 112Russell, KS 67665

O: 785-483-7111 x7130

Mrs. Alice Quinday 815 N. MapleP.O. Box 112Russell, KS 67665

alice@russellcity.orgO: 785-483-7111 x7130

Alice Quinday City of Russell Fire Department

Printed On: 17 May 2018 Requests of more than $5,000 2

Application Form

Organization InformationVerification of tax-exempt status* Organization is:

Government entity

Verification of status Please note: Applications from public charities (501(c)3 organizations) are required to attach verification of charitable status in order to be considered. A state sales tax exemption DOES NOT complete this requirement. Applications from churches and/or government entities are not required to attach a verification document.

Physical Address If the physical address of your organization is different than the mailing address, please enter your physical address below.

City of Russell Fire Department815 N. Maple St.Russell, KS 67665

Project InformationProject Name* Name of Project.

SCBA Equipment

Amount requested* $53,290.00

Primary objectives* The Foundation has six primary objectives. Which of these does your program or project best addresses:

Community Social Services & Security

Alice Quinday City of Russell Fire Department

Printed On: 17 May 2018 Requests of more than $5,000 3

County or Counties Served* Please check the primary county served by the program/project for which you are requesting funds.

Russell

Communities Served* Please list the primary community served by the program/project for which you are requesting funds.

City of Russell

Strategic Doing Project* Was this application generated through the Strategic Doing initiative?

No

Target Population* Please check one or more populations served by the program/project for which you are requesting funds.

All

Project Description* Briefly describe the program/project for which you are requesting funds.

Currently our department is operating with 14 air packs that are 17 years old. Within our five year budget for Fire Equipment, which is funded from property taxes only and varies annually, we have set aside money to purchase 2 complete SCBA's sets a year, which include one air pack and one air cylinder. With having 14 air packs that are way past their life span, it would take us seven years or more to replace the air packs needed now. We also found out, that in March of 2019 the air packs we use will be discontinued and the replacement brand will be going up ten percent of what the cost is now for each. In 2019, we will also be faced with having to replace 12 air cylinders. This will take another 6 years or more, so we are continually trying to play catch up with lifesaving equipment for our firefighters. We applied for a Firehouse Subs grant to help obtain some of this equipment, and were awarded $27,912.00, which will allow us to purchase 4 air packs and 4 air cylinders. We will also be able to buy 2 more air packs and 2 cylinders this year with the $14,000.00 we already have budgeted. This equipment will help our department by giving our fire fighters the assurance of the reliability of the equipment.

Grant Request Description* If funded, how will you specifically use the Dane G. Hansen funds?

If funded, the funds will be specifically used to purchase the remaining outdated SCBA's needed to have updated equipment. These air packs hold the air cylinders so that our firefighters can safely breath while on a structure fire or on a hazmat scene.

Alice Quinday City of Russell Fire Department

Printed On: 17 May 2018 Requests of more than $5,000 4

Project Objectives* What do you hope to achieve and how will it benefit the people of Northwest Kansas?

We hope to achieve the ability to purchase all of the outdated equipment needed this year. The total cost of this project will be $95,202.00, this will only be achieved if awarded the amount applying for, combining the budgeted amount from the City and the money awarded by the Firehouse Subs Grant. The benefit will be the reliability of the equipment, keeping our firefighters safe and protected while on scene. Also allowing them to fight the fires with less breaks by having a more reliable piece of equipment.

Timetable for the Project* When is the project projected to begin and end? For ongoing projects, when will the Dane G. Hansen funds be utilized?

The project will begin when the grant is awarded and end upon receiving the equipment. However, the equipment is expected to be useful and beneficial to the community for 14 years for the air packs and 30 years for the cylinders.

Additional Support Describe additional sources of support (if any) that have been secured or that will be pursued for this project.

We have additional support from the Firehouse Subs grant that was awarded in the amount of $27,912.00, plus the City's contribution of $14,000.00

Evaluation* How will you evaluate the success of the project/program? Be specific. (If funded, this will be helpful when completing the final grant report.)

The success of the project will be measured by equipping the firefighters with reliable and safe equipment

Sustainability* How will the project/program be sustained in the future? (For capital projects, how will you maintain or operate the item or facility?)

If awarded the grant, the project will be sustained by being able to purchase the SCBA's ahead of their life span and allow us to maintain the replacements in our budgeting for years to come. This will allow for the firefighters to have the security they need in their fire equipment.

Supporting DocumentsProposal Budget* Complete the budget form attached on the Grant Criteria page under document requirements and upload here.

Budget - SCBA-Airpacks.xlsx

Alice Quinday City of Russell Fire Department

Printed On: 17 May 2018 Requests of more than $5,000 5

Balance Sheet* A detailed financial statement is required. Please do not attach your entire audit report. An example can be found on the Grant Criteria page, under document requirements.

Balance Sheet 2016 Audit.pdf

Income Statement* A detailed financial statement is required. Please do not attach your entire audit report. An example can be found on the Grant Criteria page, under document requirements.

Summary Statement.pdf

Board of Directors* Please attach a list of your board members. (Name and title, no biographies.)

Council list 2018.pdf

Bid or Quote A copy of the bid or quote is required for a capital project or purchase.

Quote.pdf

Letter of Support 1 A letter of support may be attached, but is not required.

Letter of Support 2 A second letter of support may be attached, but is not required.

Letter of Support 3 A third letter of support may be attached, but is not required.

Additional Documents If there are additional documents that are critical to the trustees’ understanding of your proposal, upload them here.

Alice Quinday City of Russell Fire Department

Printed On: 17 May 2018 Requests of more than $5,000 6

Electronic SignatureSignature of Applicant* By entering my full legal name here, I warrant the truthfulness of the information provided in this application.

Shane Prestion

Title of Applicant* Fire Chief

Signature of Principal or College President (if required) By entering my full legal name here, I warrant that I have read and support this application.

Title of Principal or College President

Signature of CEO, Director, Mayor, etc. If this request is for a City, 501 (c)(3) Organization, Government Entity, etc., the signature of the CEO, Director, Mayor, etc., is required.

By entering my full legal name here, I warrant that I have read and support this application.

Jon Quinday

Title of CEO, Director, Mayor, etc. City Manager

InternalTracking Number*

2018-6-7

501c3* Yes

Alice Quinday City of Russell Fire Department

Printed On: 17 May 2018 Requests of more than $5,000 7

File Attachment SummaryApplicant File Uploads• Budget - SCBA-Airpacks.xlsx• Balance Sheet 2016 Audit.pdf• Summary Statement.pdf• Council list 2018.pdf• Quote.pdf

Dane G. Hansen Project Budget FormOrganization: City of Russell Fire DepartmentProject name: SCBA Equipment

List project expenses (be specific)Self-contained breathing apparatus (SCBA) air packs and cylinders $95,202.00

$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00$0.00

*Total Project Expenses $95,202.00

Project Revenue Secured Applied-for Earned

In-kind donations can be included- provide equitable dollar amount. Budgeted funds,gifts received, etc

(Grants, Pendingdonations)

(Fees, ticketsales, etc)

Dane G. Hansen Foundation Request $53,290.00Firehouse Subs Grant $27,912.00 $0.00 $0.00City of Russell $14,000.00 $0.00 $0.00

$0.00 $0.00 $0.00$0.00 $0.00 $0.00$0.00 $0.00 $0.00$0.00 $0.00 $0.00$0.00 $0.00 $0.00$0.00 $0.00 $0.00$0.00 $0.00 $0.00$0.00 $0.00 $0.00

TOTALS $41,912.00 $53,290.00 $0.00

*Total Project Revenue $95,202.00

*Revenue and Expense totals should be the same.

TITLE NAME

Mayor Curt Mader

WARD I

Council Member Michelle Wagner

Council Member Frank Peirano

WARD II

Council Member Barry Alan Hoffman

Council Member Bill Dollison

WARD III

Council Member Blaine Stoppel

Council Member Jim Cross

WARD IV

Council Member Richard Cross

Council Member G.J. Long

CITY OF RUSSELL

MAYOR AND COUNCIL MEMBERS

Quote

Date 5/2/2018Quote # QT1173842

Bill ToRUSSELL, CITY OF FIRE DEPTP.O. BOX 112RUSSELL KS 67665United States

Ship ToRUSSELL, CITY OF FIRE DEPT815 MAPLERussell KS 67665United States

Expires 12/21/2018

Sales Rep Backman, Randall

PO #

Shipping Method FedEx Ground

1900 East Military AvenueSuite 276Fremont, NE 68025

ItemX3314021200302

Alt. Item # Units Description4.5 X3CGA, SH PTKR/DEBSS

QTY10

Unit Sales Pri...5,329.00

Amount53,290.00

SubtotalShipping Cost (FedEx Ground)

Total

53,290.000.00

$53,290.00

Sales RepRandy Backmanrbackman@mesfire.comThis will ship at no chargeMES1900 E Militry avesuite 276Fremont Ne 68025

QT1173842

This Quotation is subject to any applicable sales tax and shipping & handling charges that may apply. Tax and shipping charges areconsidered estimated and will be recalculated at the time of shipment to ensure they take into account the most current local taxinformation.

All returns must be processed within 30 days of receipt and require a return authorization number and are subject to a restocking fee.

Custom orders are not returnable. Effective tax rate will be applicable at the time of invoice.