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Home My WebLink AboutCOM 0010.015 2006-2008 x.o. Ord ocp-7`) Harry Ham ~ ~ Darryl J. Oliveira Mayor Fire Chief %;%•....:y+ Glen P. I. Honda rr of x• Depaty Fire Chief County of Hawaii FIRE DEPARTMENT 25 Aupuni Street • Suite 103 • Hilo, Hawaii 96720 (808)981-8394 Fax (80S)981-2037 r~ DATE: August 23, 2007 - TO: Pete Hoffinan, Council Chairman and Council Members r FROM: Hawaii Fire Department RE: FINAL REPORT Name of Grant Program: Community Facilities Grants Federal or State Grantor: U.S. Department of Agriculture County Grantee Department or Agency: Hawaii Fire Department Grant No. (IF KNOWN): 61-001-099 Amount of Grant: 19,500 Amount of County Match: 6,500 County Revenue Account Number: 3303.87 Grant Period (Commencement & Completion): 5/20/05 - 5/20/10 Goals: Enhance Rescue capabilities of first responders to auto accidents Objectives: Provide vehicle extrication tools for Pahala Fire Station Outcomes or Results: Subject tools have been purchased. 15 firefighters received factory authorized training. Tools have been assigned to Pahala FiXe Station, Engine 11. Comm. Ne. ~ Ref. To: ~ ~ ~^W^~~ Ref. Uate AUG 2 7 20Q7 ~Rro~ Fo Haumi'i County is an Equal Opportunity Provider and Employer. •~SY Y! ~i Harry Kim ' " ~ Darryl J. Oliveira Mager FYe CY,kf ~ Glen P. I. Hoada ea ivy Deputy Fire CFIef County of Hawaii FIRE DEPARTMENT 25 Aupuui Street • Suite 103 • Hilo, Hawaii 96720 (808)981-8394 • Faz (808)981-2037 August 21, 2007 Mr. Ted Matsuo USDA Rural Development Room 311 154 Waianuenue Avenue Hilo, Hawau 96720 Dear Sir: SUBJECT: Communiri Facilities Grant - Pahala Extrication Tool Enclosed are the final report documents for the subject grant: Request for Advance or Reimbursement, Standard Form 270 Financial Status Report, Standard Form 269A Supporting purchase order, invoice, and delivery tag. Thank you for allowing our participation in this program Sincerely, I)' L OI ~ . Fire Chief aAWAti " OMB APPROVAL NO. PAGE OF 0348-0004 1 2 PAGES REQUEST FOR ADVANCE ,,,-,,,,,,a,,,,,,, 29A515 OF REQUEST OR REIMBURSEMENT ~ ?ADVANCE m REIMBURSE- TYPEOF MENi OCASH PAYMEM S. Xtle applivhb EUr (See InsWCtlons on back) REOUESTEO ? FINAL ? PARTIAL ? ACCRUAL a. FEDERAL aPONBOmNG AGENCY AND ORGIWZlT10NAL ELEMEMTO d. FEDERAL GRANT OR OTHER 5. PARTIAL PAYMENT REQUEST WHICH TRIG REPORT 55UBMITTED IDBJIIFYING NUMBER ASSIGNED NVMBER FOR TWS REQUEST BV FEDERAL AGENCY USDA Rural Development Community Facilities Grant - Pahala 1 6. EMPLOYER IOEfmFICATN7N T. REpPIENI'S ACCOUNrrJUMBER 8. PERIOD COVERED BY THIS REQUEST NUMBER OR IDENTIFYING NUMBER FROM (month, tlay yrad TO (monM, day, yerJ 99-6000567 610010996000567 05/20/2005 09/30/2007 D. REGPIENTIXtGANVATaNJ f 0. PAYEE (Where check is b be sentYdrrereM than ttem a) Name: County of Hawaii Fire Department Name: Number Number and Sheet 25 Aupuni Street, Room 103 and sheep. City, State City, Sfate eM LP Code: HflO, HI 96720 and LP Code: 11. COMPUTATION OF AMOUNT OF REIMBURSEMENTS/ADVANCES REQUESTED PROGRAMS/FUNCTIONS/ACTIVITIES ? Equipment Purchase TOTAL a. ToW program tAaddsb~ $ 24,995.36 $ $ $ 24 995.36 to date b. Less: Cumulagve ram income O.OO Net program outlays (f-ma a MnMS 24,995.36 0.00 0.00 24,995.36 Meb d. Estimated net cash outlays for advance _ O.OO e. Total Sum o/Ines c 8 ~ 24,995.36 0.00 0.00 24,995.36 f. Non-Fetlerel share of amoulrt on urge a 6,248.84 6,248.84 . Federal share of amount on ine a 18,746.52 18,746.52 h. Federal vb ted O.OO i. Federal snare now requested (une g 1$,746.52 0.00 0.00 18,746.52 minus ine h) I- Advances required by month, when requested lstmonth ~ O.OO by Federal grantor agency far use h making 2nd month O.OO presdroduled advances 3rd month O.OO 12. ALTERNATE COMPUTATION FOR ADVANCES ONLY a. Estimated Federal cash outla that will be made du ' rbd covered the advance $ b. Less: Estimated balance of Federal cash on hand as of fmJ of advance e. Amount nested ne a minus ine b) $ O.OO AUTHORED FOR LOCAL REPRODUCTION (COntlnued on Reverse) STANDARD FORMYla tRe+. 7-97) Prescribed by OMB Circulars A-102 and A-110 t3. CERTIFICATION SIGNA7IXZE RAlm10R~DGERTIFYING GFFIGIAL DATE REWESr I ceAity that to the best of my sueMrrreD knowledge and belief the tlata on the reverse are correct and that all outlays August 20, 2007 were made in BCCOrdanCe Wltll the OR PRI NA TIRE TELEPIpklE (AREA grant cerld3iolls or omer agreement coot; uunlaER, and that payment is due and Hors not Darryl J. Olivei ,Fire Chief I~CIErLSIONI been prevbusry requested. (808)981-8394 This space for agency use Pubrc reporting burden for tl>Is cdlection of Mformatlon is estimated to average 60 rMrtutes per response, inGudirg time for reviewing ttstnectlons, searcNng etassdrg data sources, gathelvg and tTRtkttaining the data needed, and completing and reviewing the celteetion of Infomtation. Send contrnert5 regarding ate Darden estimate or any otlter aspect of tltis edleGMt of Infortrtatlon, htclllding suggestions for reductg this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0004), Washington, DC 20503. PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND Bl1DCET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. INSTRUCTIONS Please type or print legibly. ttems 1, 3, 5, 9, 10, 11e, 1 tf, 11g, 11 i, 12 and 13 are self-explanatory; specific instructions for other items are as follows: kem Entry Item Enay 2 Indicate whether request is prepared on cash or accrued activity. If additional columns are needed, use as many expenditure basis. All requests for advances shall be addttional forms as needed and indicate page number in prepared on a rash basis. space provided in upper right; however, the summary totals of all programs, functions, or activities should be 4 Enter the Federal grant number, or other identifying shown in the "total" column on the first page. number assigned by the Federal sponsoring agency. If the advance or reimbursement is for more than one grant 11 a Enter in "as of date," the month, day, and year of the or other agreement, insert N/A; then, show the aggregate ending of the accounting period to which this amount amounts. On a separate sheet, list each grant or applies. Enter program outlays to date (net of refunds, agreement number and the Federal share of outlays rebates, and discounts), In the appropriate columns. For made against the grant or agreement requests prepared on a cash basis, outlays are the sum of actual cash disbursements for goods and services, 6 Enter the employer identification number assigned by the the amount of indirect expenses charged, the value of in- U.S. Internal Revenue Service, or the FICE (institution) kind contributions applied, and the amount of cash erode if requested by the Federal agency. advances and payments made to subcontractors and subrecipients. For requests prepared on an accrued 7 This space is reserved for an account number or other expenditure basis, outlays are the sum of the actual identifying number that may be assigned by the recipient cash disbursements, the amount of Indirect expenses incurred, and the net increase (or decrease) in the 8 Enter the month, day, and year for the beginning and amounts owed by the recipient for goods and other ending of the period covered in this request. If the request property received and for services performed by is for an advance or for bout an advance and employees, contracts, subgrantees and other payees. reimbursement, show the period that the advance will cover. If the request is for reimbursement, show the ttb Enter the cumulative cash income received to date, if period for which the reimbursement is requested. requests are prepared on a cash basis. For requests prepared on an accrued expendtture basis, enter the Note: The Federal sponsoring agencies have the option of cumulative income earned to date. Under etther basis, requiring recipients to complete items 7 7 or 12, but not enter only the amount applicable to program income that both. Item 12 should be used when only a minimum was required to be used for the project or program by amount of information is needed to make an advance and the terms of the grant or other agreement. outlay information contained in ttem 11 can be obtained in atimelymannerfromotherreports. 11d Only when making requests for advance payments, enter the total estimated amount of cash outlays that will 11 The purpose of the vertical columns (a), (b), and (c) is to be made during the period covered by the atlvance. provide space for separate cost breakdowns when a project has been planned and budgeted by program, 13 Complete the certification before submitting this request. function, or aTANDARO FORM 27a (Rev. 7b7/ axk FINANCIAL STATUS REPORT (Short Form) (Follow instructions on the back) 1. Federal Agency arts Organ¢a8onal Element 2. Federel Grantor Other Idenfitying Number Assigned OMB Approval Page of to which Report is Submitted By Fede21 Agency No. USDA Rural Development Community Facilities Grant - Pahala a3ae-0o3s 1 1 pages 3. Redpient Organization (Name and complete address, including ZIP code) County of Hawaii Fire Department, 25 Aupuni Street, Room 102, Hilo, Hawaii 96720 4. Employer Idenfification Number 5. Redpient Account Number or Identifying Number 6. Final Report 7. Basis 99-6000567 610010996000567 Yes ? No? Cash ? Accrual 8. FundinglGrent Period (See inshuc6ons) 9. Pedod Covered by this Report From: (Monts, Day, Year) To: (Month, Day, Year) From: (Month, Day, Year) To: (Month, Day, Year) 5/20/2005 5/20/2010 5/2012005 9!30/2007 10. Transactions: I II III F'reviousty This Cumulative Reported Period a. Total outlays 0.00 24,995.36 24,995.36 b. Redpiern share otoutlays 0.00 6,248.84 6,248.84 c. Federal share of outlays 0.00 18,746.52 18,746.52 s, E• d. Total unl'puidated obrga8ons ~ t t _ _~I~,"v ~ ~ 0.00 e e. Redpient share of unliquMated obligations - ~r~^".,~ r .4~~ Ott 0.00 ~x L Federal share of udiquidate0 obligafions S,7 ~_g+~, ~ ' 0.00 _ w ~ r gr ,t T ry g. Tofai Federal share(Sum ollines c and 0 ~ ~'P,cp ~ ~ ~ 18,746.52 x~'~dr ~ € xi ~ ,firs ~~rr d~ - h. Total Federal funds author'¢sd for this funding period - n ~ - ~ 18,746.52 L Unobligated balance of Federal fund~Lfne h minus line g) ~ ~ ~,..N a ~ 0.00 a. Type d Rate(Place X' in appropriate box) 11. Indirect ? Provisional ? Predetermined ? Finai ? Fixed Expense b. Rate c. Base d. Total Amount e. Federal Share 12. Remarks: Attach any exylanations deemed necessary or information required try Federal sponsoring agency in compliance with governing legislation. See attachment. 13. CerBfirafion: I eeRity to the best of my knowledge and belie(thaf this report is correct and eanplete and that all outlays and unliquidated obli ations are for the purposes set forth in the award documents. Typed or Printed Name and Title Telephone (Area code, number and extension) Darryl J. Oliveira, Fire Chiet (808)981-8394 Signature o uthodzed Cedifying Offidal Date Repod Submitted August 8, 2007 NSN 40-01-2 387 269-202 Standard Forn 269A (Rev. 7.97) Prescribed by OMB C'ucuWrs A-102 and A-11( Hawaii Fire Department Attachment to Standard Form 269A, item 12 in compliance with Hawaii County procurement procedures, a purchase order for Holmatro brand extrication tools was issued on 3/13/07 to Pacific Extrication LLC. The equipment was received on 6/20/07. Manufacturer representatives conducted training sessions on the use of the extrication tools for fifteen (15) Pahala Fire Station firefighters on August 1-3, 2007 in Hilo. The tools have since been assigned to Pahala Fire Station Engine 11. CUUiWTY OF FiAWAI'1 Page 1 / 1 DEPARTMENT OF FINANCE -PURCHASING DIVISION 25 AUPUNI STREET HILO, HAWAII 96720 03/13/2007 R.005736 (808)961-8231 FAX (808) 961-8248 Hawaii County is en Equal Opportunity Provider and Empbyer SHIP TO: FIRE WAREHOUSE 466 KINOOLE ST HILO, HI 96720 Special Inst: VENDOR: 27682 FOB Point PACIFIC EXTRICATION LLC Terms: A/P Net 30 Days 7455 CIRCULO SWOUOIA Req. Del. Date: 12292006 CARLSBAD, CA 92009 Req• No•: fd.00453 Dept: Fire Dept Req Conrad Name: Mento, Quince Confad Phone: (808) 96t-8094 ConfirmtngY No (If Yes, DO NOT Duplicate) 1.00 ea IFB22721TEM1 24,994.3100 24,994.31 ExhigSon Tools - Holmatro Rescue Equipment Delivery within 70 days after receipt of Purchase Order 9+#~' °k # I, oS tQ.~u=.h Y,D. > rauat~v ~erc ~ Iw./Or Pn"4'f r``~ .fr1?+-(~ vn4, . .~tnd,w4 ~ ~ :~y.,4 Q s . 3 t. 'w'.d,ei 07 n,,, 9 e,~~ l3 04 S 2'~ susroraL 24 994.31 Blu_T0: FIRE ADMINISTRATION Tax 0.00 25AUPUNI STREET FRElcer 0.00 SUITE 103 roraL 24,994.31 HILO, HI 96720 INSTRUCTIONS TO VENDORS: Bill at unft prices as agreed, inGuding all packing and delivery charges unless otherwise stated. PREPAY ALL FREIGHT CHARGES AND SHIP FOB DESTINATION UNLESS OTHERWISE NOTED. An original and one copy of all invoices must be mailed or delivered to the using agency at the "Bill To" address listed below. All invoices must include the Purchase Order Number and the Requisition Number. No alteration of this order will be allowed unless approved by the Purchasing Division. Strict compliance with-these instructions will facilitate payment. Thank You. ~ . anRrue_ r. r.r=ur Invoice DATE INVOICE # yam. ~ 6/79/07 109 Q ~ - ' Z'd~~I1 . BILL TO SHIP TO Purdtasing Div Dept of Fnance Cotmry of Hawaii Fire Wharehouse 891 Ululani Street, Room 226 4661Gnoole Street Hilo, Hawai i 96720 Hilo, Hi 96720 Ref: Bid Spec 2272 Police & Fire Items DUE DATE P.O. NUMBER 7119!07 Bid 2272 ITEM DESCRIPTION QTY RATE AMOUNT 158.152.118 Hdrt>aUo DPUGO Sinro Purnp w/Honda & Core Tech 1 7,585.00 7,585.007 156.072.059 Hdrnatro 4242, 27" Hydraulic Spreader 1 5,635.00 5,635.007 158.012.056 Hdmatro 4020 Cutter 1 4,267.00 4,267.007 158.032.009 lidmatro 4321 Ram 1 2,872.00 2,872.007 150.181.321 Hdmatro 6.5 Inch extension for the 4321 Ram 1 273.00 273.001' 150.181.322 Holmatro 13 loch e~densfon for the 4321 Ram 1 315.00 315.007 150.181.323 fiolmafro 23.5 inch extension for the 4321 Ram 1 351.00 351.007 150.181.325 Hdmatro Con'xaI Poird (Ram Accessories) 1 128.00 128.007 150.181.324 Hclmatro Wedge Head (Ram Accessories) 1 149.00 149.007 150.181.326 Hdmatm Base Plate (Ram Accessories) 1 149.00 149.007 158.562.002 Holmatro PuQng Set (NFPA Compliant) Adapters for Rams 1 522.00 522.007 158.582.f>01 Fidrrratra Pining Chain Se! 1 228.00 228.007 158.572.128 Holmatro Core 32Ft Hose (Blue) 1 780.00 780.007 15$.572.125 HolntaLo Core Hose 32FT. (Orange) 1 780.00 780.007 Thank you for your twsiness! Subtotal 24,034.00 4% Tax 961.36 Total 24,995.36 7455 Circulo Sequoia, Carlsbad CA 92009 Email: Jami cificextrication.com Website: www oacificexMcation com h o I m at ro Hoimatro Ina packing List 505 McCOrtnkk Drive Glen Bumle, Maryland 21061 USA .rescue equipment Phone: 410.768-9662 Order: S246026 Fax: 410-768876 email: info@holmaVo-usa.eom Bil[ To: 0001420 Ship To: 26 PACIFIC EXTRICATION, LLC FIRE WAREHOUSE 7455 CIRCULO SEQUOIA t 466 KINOOLE STREET CARLSBAD, CA 92009 ~ HILO, HI 96720 USA L~~ IV USA ~ 'V ~ Phone: (760) 634-6910 S ,,,t~ Phone: (760) 634910 Cult PO: 200701 Sh iipfi ra: BEST WAY Caniact: Jamie Carpenter End User: HI COUNTY FD, HI Line Article Description UM Ordered Shipped BO Qty 1 158.152.118 DPU60PH HONDA DUO PUMP CORE EA 1 1 0 S/N: 1581521181399 2 Z - 675w 2 158.012.059 4242 SPREADER CORE EA 1 1 0 S/N:158012059757 3 158.012.056 4020 CUTTER CORE EA 1 1 0 S/N:15801205649 4 158.032.009 4321 RAM CORE EA 1 1 0 S/N:158032009110 5 150.181.321 EXTENSION 6.5' FOR RAM EA 1 1 0 6 150.181.322 EXTENSION 13" FOR RAM EA 1 1 0 7 150.181.323 EXTENSION 23.5 FOR RAM EA 1 1 0 8 150.181.325 CONICAL POINT FOR 3321122 EA 1 1 0 9 150.181.324 WEDGE HEAD FOR 3321/22/32 EA 1 1 0 10 150.181.326 PLATE BASE FOR 3321/'22/32 EA 1 1 0 11 158.582.002 PULLING SET ASSEMBLY RAM EA 1 1 0 12 158.582.001 PULLING CHAIN SET GENERAL PURPOSE EA 1 1 0 13 158.572.128 HOSE CORE 32 BLUE EA 1 1 0 14 158.572.125 HOSE CORE 32 ORANGE EA 1 1 0 Wednesday, May 30, 2007 Page 10. f I .r