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HAWAII COUNTY FIRE DEPARTMENT <br />BUDGET REQUEST & JUSTIFICATION <br />Type or print clearly. <br />[.REQUEST <br />A. Description: Zoll Pacemaker/Defibrillator/Monitor. PD -1400, complete with multi -function cable. carrvina <br />case. cross-over cable/MF electrode option. 4X4 battery charaQt/testVr <br />B. Describe features needed: See attached specs. <br />C. Cost (Estimate Only):_$23 000 00 Brand & Model ZollPD 1400 Source (if known)ifg <br />Science Resource INC <br />D. —Additional Item X Replacement _For New Position <br />IF REPLACEMENT, GIVE THE FOLLOWING INFORMATION: <br />1. County 1D# To be determined later 2. Item <br />3. Date Purchased <br />II USES <br />A. Item to be used for (Purposes): To replace 2 older units presently in service. due to age and normal wear and <br />tear units need to be replaced on a rotational bases. <br />B. Describe how work is currently performed: With older units. <br />C. Additional Justification: <br />III. Station Priority: 2 <br />(Example: If 12 items (forms) are submitted by the station, they <br />should be numbered in order of importance from 1 to 12.) <br />STATION: EMSDivision <br />DATE:_Q9- 77-96 <br />STATION COMMANDER: B C. Paul Paiva REQUEST INITIATOR: <br />ACTION: ' DEPT USE ONLY . <br />_Budget as Dept Priority:_ _Do not budget <br />17—i 9 <br />