Audiovox ACD-28 Specifications

Notice to Bidders
Tompkins County
Department of Emergency Response
Air Support Vehicle
Sealed Bids for the purchase of an Air Support Vehicle will be accepted at the Tompkins County Finance
Department, Purchasing Division, 125 East Court Street, Old Jail Building, 2nd Floor, Ithaca, NY 14850 up until
11:30 a.m. on July 27, 2011 at which time and place they will be opened and publicly read.
Specifications and bid forms may be obtained upon registration at the following website: or by contact Lisa Jehu at (607) 274-5500, or
Tompkins County reserves the right to reject any or all bids.
Lisa M. Jehu
Instructions to Bidders
1. Read all documents contained in this bid specification package.
2. Bidders are responsible for submitting their bids to the exact location indicated in the “Notice to
Bidders” prior to the time indicated in the “Notice to Bidders”. Bids will not be accepted after the
designated time in the “Notice to Bidders” and will be returned to the vendor unopened. NOTE: This
includes any changes listed on the latest addendum issued, if any. Delay in the mail delivery is not an
exception to the deadline for receipt of bids.
3. Bidders are responsible for reporting, in writing, any errors found in the bid specifications to Tompkins
County Purchasing, 125 E. Court Street, Ithaca, NY 14850, or Failure to
report errors constitutes acceptance as written.
4. Questions about, or clarifications to, the technical specifications must be made in writing to Tompkins
County Purchasing, address above, prior to the bid opening. Such questions must be received by the
buyer at least five (5) calendar days prior to the bid due date unless otherwise indicated. Verbal
questions may not be entertained.
5. The County reserves the right to “Revise” or “Amend” the bid specifications prior to the bid opening
date by written “Addenda”. It is the responsibility of the bidder to ascertain whether any addenda have
been issued by checking with the Purchasing Division prior to submitting their bid.
6. No charge shall be allowed for federal, state, municipal sales, surcharges, or excise taxes from which the
County is exempt. Exemption certificates will be forwarded to the successful bidder upon request.
7. Bidders shall indicate on the outside of their sealed bid the following information:
A. Title of Bid
B. Date & Time of Bid Opening
C. Company Name
Bidders submitting “alternate” pricing, products, or services must do so as a separate bid package
unless otherwise specified, to be considered for award. Each bid must be submitted under separate
cover and will be considered on its own merits.
Bidders must submit one original bid package(s) with original signatures and one copy of their bid
8. In an effort to promote greater use of recycled and environmentally preferable products and minimize
waste, all responses submitted should comply with the following guidelines:
A. All copies should be printed double sided
B. All submittals and copies should be printed on recycled paper with a minimum postconsumer content of 30%.
C. Unnecessary samples, attachments or documents not specifically asked for should not be
9. The following forms are to be submitted with the bid package:
A. Tompkins County bid form, filled out in its entirety
B. Non-Collusive Affidavit, signed and dated
C. Insurance Certificate, completed and signed by insurance agent
D. Anti-Discrimination Clause, signed and dated
E. References as indicated in the bid specifications
F. W-9 Request for Taxpayer Identification Number and Certification
G. Bid Sign-Off Sheet, filled out in its entirety
H. Any other information required in the bid specifications
Under no circumstances is it necessary to return the technical specifications with the bid. The bidder
should retain them for their records.
10. Bidders submitting a bid will be supplied with a copy of the bid tabulation, upon request, with the bid
award information as soon as they become available.
11. Failure to submit any of the above data may result in the rejection of the bid as non-responsive.
Furthermore, the County reserves the right to require the vendor to supply any additional information
it deems necessary to determine the successful responsive/responsible vendor and further to waive any
minor informalities it deems to be in its best interest.
12. All bids submitted to Tompkins County become the property of Tompkins County and are subject to
Public Information Policy. Any confidential information, such as a company’s financial status, if
required by the specifications, shall be submitted in a separate sealed envelope with the word
“CONFIDENTIAL” on the outside.
13. The apparent silence of the specifications as to any details or the omission from it of a detailed
description concerning any point shall be interpreted as meaning that only the best commercial
practices are to prevail and that only materials and workmanship of first quality are to be used,
specified or accepted.
14. Tompkins County reserves the right to consider a bid “incomplete” or “non-responsive” if it is not
submitted in accordance with the provision of the specifications, or to waive informalities in any bid as
received. The County also reserves the right to reject any and all bids that do not prove to be in the best
interest of the County without cause.
Method of Award:
The County reserves the right to award the
contract(s) to the bidder(s) that the County
deems to offer the lowest responsive and
responsible bid(s). The County has the sole
discretion and reserves the right to cancel this
bid, reject any/all bids, to waive any/all
informalities and/or irregularities, or to readvertise with either the identical or revised
specifications if it is deemed to be in the best
interest of the County to do so. The County
guarantees no minimum or maximum
contract(s) as a result of award of this bid.
Contract Extension:
The County reserves the right to allow all
municipal, school districts, and not for profit
organizations authorized under the General
Municipal Laws of New York State to purchase
any goods and/or services awarded as a result of
this bid in accordance with the latest
amendments to the New York State General
Municipal Law 100 through 104. However, it is
understood that the extension of such contracts
are at the discretion of the vendor and the
vendor is only bound to the contract(s) between
the vendor and the County.
Environmentally Preferable Products:
Environmentally preferable products are those
that have a lesser or reduced effect on human
health and the environment when compared
with competing products that serve the same
purpose. This comparison may consider raw
materials acquisition, production,
manufacturing, packaging, distribution, reuse,
operation, maintenance, or disposal of the
product. Bidders able to supply products
containing recycled and environmentally
preferable materials that meet or exceed the
specifications and performance requirements
are encouraged to offer them in bids and
Qualification of Bidder:
Bids will only be accepted from established
manufacturers or their authorized dealers. In
the event a dealer submits a bid, the dealer shall
guarantee that they are an authorized dealer of
the manufacturer and the manufacturer has
agreed to supply the dealer with the
product/equipment offered in the bid.
Bidder Responsibility:
The bidder, by submitting a bid, represents that:
A. The bidder has read and understands the
specifications in their entirety and that the
bid is made in accordance therewith, and;
B. The bidder possesses the capabilities,
resources, and personnel necessary to
provide efficient and successful service to
the County, and;
C. The bidder will be held responsible for any
and all discrepancies, errors, etc., in the
discounts or rebates which are discovered
during the contract term or up to and
including three (3) fiscal years following the
County’s annual audit.
The bidder shall guarantee that the product(s) or
equipment provided is standard new products or
equipment (unless otherwise requested), latest
model of regular stock product and in current
production. Replacement parts shall be easily
obtained and that no attachment or part (if
applicable) has been substituted or applied
contrary to the manufacturer’s
recommendations and standard practice. Every
product delivered shall be guaranteed against
faulty material and workmanship for the term of
the contract. If during this period such faults
develop, the product(s) shall be replaced at no
cost to the County.
Term of Contract:
Unless otherwise specified, any contract
resulting from this bid shall be for one year with
the option to renew for up to three (3) additional
twelve (12) month periods by mutual agreement
in accordance with the terms of the contract.
Award of Bid:
The award, if any, will be made within forty-five
(45) calendar days of opening date. No bidder
may withdraw their bid within thirty (30) days
after the bids are due, however, bids may be
withdrawn at any time prior to the bid due date
and opening. Notice of award will be sent to all
successful bidders. Unsuccessful bidders shall
not be notified.
Delivery Penalties:
Delivery terms shall be stated in the detailed bid
specifications. By signing the bid forms the
vendor agrees that they are able to meet the
specified delivery requirements. A penalty fee of
$10.00 per calendar day, for each day the
item(s) ordered are not delivered to the proper
County location may be assessed. In the event
that the item is on backorder through no fault of
the vendor the vendor is required to inform the
County immediately. Late penalty fees shall be
deducted from the invoice once the item is
received by the County.
10. Invoices:
Invoices shall be mailed directly to the ordering
department. Invoices mailed to the incorrect
location may not be forwarded thus causing
delay in payment.
11. Tax on Materials:
In regard to any taxes applicable to this project,
please acquire a copy of form ST-120.1 from the
New York State Department of Taxation and
Finance and follow accordingly. Tompkins
County is tax exempt. Tax exempt certificates, if
required, will be forwarded upon request.
12. Incurred Expenses:
This Invitation to Bid does not commit the
County of Tompkins to award a contract, nor
shall the County of Tompkins be responsible for
any cost or expense which may be incurred by
the bidder in preparing and submitting the bid,
or any cost or expense incurred by the bidder
prior to the execution of a contract.
13. Failure to Perform:
In the event the equipment and/or products fail
to perform to the County’s expectations the
vendor shall, at its own expense, repair or
replace said item(s).
14. Contract(s):
The successful bidder will be required to sign a
Tompkins County contract. Tompkins County
will not sign any company’s service agreement,
contract or any other form of agreement.
Tompkins County reserves the right to extract
certain language from a company’s agreement
and incorporate it into a Tompkins County
contract if mutually agreeable.
15. Financing of Material or Equipment
When any bid includes the lease and/or
purchase of material and/or equipment the
vendor shall submit a price on the bid form
provided by the County. The price offered shall
include all delivery, installation (if applicable),
finance, and any other charges that may be
associated with said purchase or lease. The
County shall only deal with the
contractor/vendor actually submitting the bid
AND arrangements made between the vendor
and any other party as a part of this bid are
strictly between those parties and the County
shall not be included or required to participate
in them in any way. Furthermore, the County
shall only make payments directly to the vendor
awarded a contract and issued a purchase order
or authorization to proceed. The County shall
not make partial or pre-payments of any kind
unless stipulated in the specifications by the
16. Pricing Adjustments:
Pricing adjustments will only be considered at
the time of bid renewal. If, in the opinion of the
County, any price adjustment request is in
excess of that acceptable to the County the
County reserves the right to reject the proposed
increase and seek new bids.
17. Non-Appropriation Clause:
In accordance with New York State General
Municipal Law, the County will not be liable for
any purchases or contracts for goods or services
for which funding is not available. As a result,
the vendor agrees to hold the County harmless
for any contracts let for which funding either
does not currently exist or for which funding has
been removed prior to the issuance of a purchase
order. Issuance of a purchase order indicates
that the County currently has set aside adequate
funds to procure the goods or services indicated
in the purchase order or the contract. Should it
become necessary for the County to cancel a
project or purchase after an order to proceed has
been issued, the County will only be liable for
and the vendor agrees to only assess those
financial damages that it can prove to have
incurred as a result of the cancellation.
18. Termination/Cancellation of Contract:
The County reserves the right to cancel the
contract without cause with a minimum thirty
(30) days written notice. Termination or
cancellation of the contract will not relieve the
bidder of any obligations for any deliverables
entered into prior to the termination of the
contract. Termination or cancellation of the
contract will not relieve the bidder of any
obligations or liabilities resulting from any acts
committed by the bidder prior to the
termination of the contract. The bidder may
cancel the resulting contract with one hundredtwenty (120) days written notice to the
Tompkins County Purchasing Division. Failure
to provide the proper notice to the County may
result in the bidder being barred from future
business with the County.
19. Substitute or “or equal” Items:
A contract, if awarded, will be on the basis of
materials and equipment as described in the
drawings or specifications and “or equal” items
submitted by the bidder and accepted by the
County. The bidder may offer “or equal” items
that meet the same performance and reliability
standards as specified herein. If the bidder
offers an “or equal” item the bidder must include
documentation with the bid package establishing
such equality. Said “or equal” items shall be
accepted or rejected based upon the County’s
evaluation of the submitted documentation. All
costs associated with the review of an “or equal”
items prior to recommendation to award shall be
at the bidder’s expense. If an “or equal” item is
rejected the bidder shall be afforded the
opportunity to meet with the County to offer
additional qualifying opinions and information
prior to bid rejection. The bidder shall not have
the opportunity to submit any alternative
materials or equipment after bids are opened.
The decision to accept or reject any “or equal”
item rests solely with the County. If a substitute
“or equal” item is not accepted by the County the
County will reject the bid. The next l0west
responsive bid will then be reviewed for award
20. Installation of Equipment:
In the event that installation of equipment is
needed the vendor shall arrange with the County
for the installation within forty-eight (48) hours
after delivery of the product(s).
21. Training:
If needed, training shall take place during
regular business hours and shall be conducted
by factory trained personnel. Training shall be
provided until all County personnel required to
use the item(s) are adequately trained. In the
event that additional training is required at any
time during the contract the vendor agrees to
supply said training at no cost to the County and
in a timely manner.
22. Deviations:
Deviations to the specifications are to be so
noted and fully explained. Tompkins County
reserves the right to accept any or all deviations
if it proves to be in the best interest of the
23. Prevailing Wages (Public Work projects
All vendors submitting bids for Public Work
projects are required to conform to all current
NYS Prevailing Wage Laws. If applicable, a copy
of the Prevailing Wage Rates applicable to the
project being bid has been attached to the
specifications. The successful vendor(s) is
responsible for complying with all current labor
rates and regulations throughout the duration of
any contract resulting from this bid. The County
will only pay and the vendor agrees only to
charge prevailing wage rates for those employees
of any organization that are required by New
York State law to receive said rates in the course
of doing work for the County. No payments will
be made to any vendor covered under this
contract prior to vendor supplying the County
with certified payrolls in accordance with the
New York State Department of Labor
regulations. Corporations and Partnerships
submitting proposals are hereby informed that
ALL personnel working on this project must be
paid the prevailing rate or above in accordance
with the current New York State Labor Laws in
effect during the term of the project. This
includes all owners, partners, and other
management and other employees as required.
Vendors currently on the NYS Department of
Labor Debarred list will not be considered for
award of this contract. By submitting a bid for
consideration the vendor is indicating that they
are currently in good standing with the NYS
Department of Labor at the time of the bid.
24. OSHA Training:
All laborers, workers and mechanics employed
in the performance of a Public Work contract
that exceeds $250,000 shall comply with New
York State Labor Law §220-h requiring
certification, prior to performing any work on
the project, as having successfully completed a
course in construction safety and health,
approved by OSHA. The course must be at least
ten (10) hours in duration.
25. Apprenticeship Programs:
Tompkins County Resolution 222 of 2004 states
that pursuant to Article 23, §816-b of New York
State Labor Law any public work that requires
separate specifications pursuant to §101 of the
General Municipal Law that exceeds $1 million
in cost, must include contractors that participate
in New York State certified apprenticeship
programs. All bidders and all subcontractors
under the bidder must maintain or participate in
a bona fide New York State Apprentice Program
approved by the Division of Apprentice Training
of the Department of Labor for each
apprenticable trade or occupation represented in
their workforce for which the law applies and
must abide by the apprentice to journeyman
ration for each trade prescribed therein in the
performance of the contract. Notwithstanding
the foregoing, each bidder awarded a contract
may allow up to twenty-five percent of the value
of its contract to be performed by employees or
subcontractors that do not meet this
requirement. Failure to comply with these
requirements may result in any or all of the
following sanctions:
A. Temporary suspension of work on the
project until compliance is obtained; and/or;
B. Withholding payment due under the
contract until compliance is obtained;
C. Permanent removal from any further work
on the project; and/or;
D. Recovery by the County from the bidder
1/10th of one percent of the contract amount
or $1,000.00 which is greater, in the nature
of liquidated damages assessed for each
week that the contractor is in noncompliance.
26. Workforce Diversity and Inclusion:
Tompkins County government is committed to
creating a diverse and fully inclusive workplace
that strengthens our organization and enhances
our ability to adapt to change by developing and
A. An organization-wide understanding and
acceptance of the purpose and reasons for
B. Recruitment and retention policies that
assure a diverse workforce;
C. A workplace environment that is welcoming
and supportive of all;
D. Awareness, understanding, and education
regarding diversity issues;
E. Zero tolerance for expressions of
discrimination, bias, harassment, or
negative stereotyping toward any person or
F. A workforce ethic that embraces diversity
and makes it the norm for all interactions,
including delivery of services to the public.
Air Support Vehicle Specifications
Scope: It is the intent of these specifications to describe an Air Support Vehicle for use by the Tompkins
County Department of Emergency Response. The following specifications describe the minimum standards
acceptable to the County.
Any deviations to the specifications are to be so noted and thoroughly explained. The County reserves the right
accept or reject any deviations.
• Overall complete unit length – 240”’ with 12” rear step
• Overall body length – 121” including rear step
• Overall body width – 96” including rub rails and fenderettes
• Overall body height – 80” from ground
Chassis Specifications
The following specifications describe a 2010/2011 Ford F-550 XLT, 4 x 4 DRW four door cab and chassis.
Color: Red
• GVWR – 19,500 lbs.
• Frame – 80,000 lbs. rating
• Wheelbase – 140.8”
• Cab to axle – 60”
• Bumper – bright finish
• Front tow hooks
• Front axle – 7,000 lbs.
• Front suspension – 7,000 lbs.
• Front tires – two (2) Michelin, or equal, sized to the specified front axle rating
• Front wheels – two (2) polished aluminum 19.5” wheels
• Black mud flaps
• Rear axle – 14,700 lbs.
• Rear suspension – 14,700 lbs.
• Rear tires – four (4) Michelin, or equal, sized to the rear axle rating. Mud and snow tread pattern.
• Rear wheels – four (4) polished aluminum 19.5” wheels
• Braking system – four (4) wheel disc brake system with anti-lock (ABS)
• Engine – diesel, 6.4L, V-8, 325 HP @ 3,000 RPM
• Cooling system – coolant mixture protected to -34° Fahrenheit, lower radiator guard installed
• Fuel tank – 40 gallon, rear mount
• Automatic transmission
• Power steering
• Batteries (1) 31 heavy-duty 12-volt battery installed, 950 cold cranking amp rating
• Cab construction – two (2) steel doors construction
• Single color cab paint
• Electric window and door lock controls
• Two (2) heated cab mirrors
• Seats – two (2) individual seats, 40/20/40 with three (3) point safety harness
Chassis specifications – continued
AM/FM radio, four speakers, rooftop antenna
Alternator – ambulance prep package with dual alternators (320 amps)
Chassis modifications:
Label installed in cab indicating seating capacity of two (2) persons with a weight allowance of 250 lbs.
per person
Data plaque, installed on inside of driver’s door with required information based on the components of
the apparatus applicable to the 2009 NFPA #1901 standards:
ƒ Engine oil
ƒ Engine coolant
ƒ Transmission fluid
ƒ Drive axle lubricant
ƒ Power steering fluid
ƒ Pump, generator or other component lubricants
ƒ Other NFPA applicable fluid levels as required
ƒ Paint manufacturer, type and color number
Dimension data label indicating the overall height, length, width and weight of the vehicle shall be
installed on the cab dash area
Warning label stating “NO RIDING ON REAR OF APPARATUS” shall be applied to the vehicle at the
rear step area. Label shall indicate that riding in or on these areas while vehicle is in motion is
Cab door shall have NFPA #1901 compliant reflective red and amber panels installed
Chassis cab shall be fitted with dual Nerf bars constructed of 304 stainless steel. Nerf bars shall serve
as lower cab door impact protection stepping surfaces for the operators
Body component specifications:
Body and mounting members shall be constructed as a singular body assembly
Entire body shall be constructed, assembled and painted as a stand-alone structure separate from the
chassis. Structure shall utilize the strength of the chassis frame rails to support the body without
requiring the structure to physically sit on the upper frame rail flange
Body construction shall be a single unit of body and compartments and mounting members. Body shall
be capable of being set on its top or sides without permanent deflection or damage to the body
Complete body and mounting members shall be removable as a single unit. The body shall have been
produced for use as fire apparatus for a minimum of twenty (20) years.
Entire assembly shall be constructed of a high strength composite with reinforced fiber and resin
construction. Exterior surface shall present a smooth glass-like appearance with a painted automotive
Body component specifications – continued:
Exterior body side walls shall be fiberglass reinforced and resin composite construction produced from
sandwiched plates with vacuum injection technology. Multiple laminates of glass fiber and resin
composite each having a minimum thickness of 3/16”. Woven and continuous glass fiber content of
composite material shall be a minimum of 40% with a maximum resin styrene content of 3%. Chopped
fiberglass fibers are not acceptable.
Exterior front, rear and side body walls shall be a minimum of 1 ½” thick. Core material shall be a
closed-cell structure approximately 1 ½” thick with a minimum density of 12 ½ pounds per square foot.
Applied injection resins shall have a minimal HT rating of 185° Fahrenheit. Laminates shall have
flame-retardant characteristics.
Body shall be completely resistant to ultra violet rays and operate in temperature ranges of -40° to
+175° Fahrenheit. The top of the body and tank shall be constructed of single laminate material with all
corners continuously sealed with resin and fiber for water tight construction.
Entire body shall be non-conductive and shall be transparent to radio waves (EMI/RFI transmissions)
Body and compartments shall be of a completely self-supporting design
Points of chassis attachment on each side and full length of the modular body shall have fully integrated
reinforced assemblies of non-corrosive composite materials in a “u” shaped configuration. Two full
length reinforced 4” high body-substructure assemblies shall be integrated into the bottom of the body
system as a single assembly serving as the points of attachment to the chassis.
Body mounting system:
Body and compartment module shall be mounted to the chassis with ten (10) mounting brackets, five
(5) each chassis frame bolted to the outside vertical frame rail.
Mounting system shall provide total torsional isolation between the chassis frame and the body module
Mounting system shall align the entire assembly longitudinally and transversely with the chassis frame
Body assembly with mounting members shall not rest directly on the upper chassis frame flange.
Frame mounting assemblies directly above and ahead of the rear axle shall be provided with springs for
an additional torsional movement.
Body module mounting assembly shall consist of the following:
ƒ 7 gauge gusseted steel frame brackets attached with no less than four (4) grade 8, ½” diameter bolts
and locking nuts installed by final stage manufacturer
ƒ Meta-cone high capacity hard rubber filled cone shaped shock-attenuating assemblies with piloted
flange washers bolted to frame brackets
ƒ Each mounting shall have a vertical grade 8, 5/8” diameter bolt with piloted flange washers and pin
or locking nut securement. All mounting nuts shall be torque to the manufacturer’s requirements
Exterior compartment construction:
Shall be integral with the body construction
Compartments shall have painted 3” vertical exterior divider panels between each compartment and at
front and rear corners of body
Compartment floor shall have a 4” horizontal structure for rub rail attachment of reinforced gusseted
composite construction
Floor assembly shall be designed to provide a “lip free” sweep-out floor surface
Exterior compartment construction – continued:
All interior corners of the compartments shall be constructed with mitered and angled 1” wide full
height or width composite gussets for waterproof construction and compartment reinforcement
Exterior corners shall be wrapped with glass fiber and resin for seamless construction and additional
Interior compartment construction:
Interior compartment wall dividers of the boy construction shall be single laminate composite material
not less than 3/8” wall thickness
Compartment ceiling and floors shall be a single laminate not less than ½” thickness
All interior corners of the compartments shall be constructed with mitered and angled 1” wide full
height or width composite gussets
Body lifting and tie-off provisions:
Body shall have four (4) removable screw-in lifting and tie-off points for attachment of eyebolts
Equipment attachment:
Threaded inserts shall be utilized to attach various bolt-on components and equipment to the surface of
the body
Inserts shall be mechanically secured to allow for any attachment to exterior panels on the body
Energy absorption:
Body construction shall have “shock absorbing” capabilities
The body shall be of totally composite construction to provide total resistance to electrolysis.
Body weight consideration:
Specified body and compartments shall be of the lightest weight material available
Thermal resistance:
Body material shall not be subject to severe expansion and contraction
Body material shall be self-extinguishing
Compartment ventilation provisions:
Body compartments shall have louver provisions in walls for ventilation
Wheel well panel construction:
The outer wheel well shall be a minimum wall thickness of 1 ½”
Exterior wheel well shall be painted to match the body
Entire wheel well area shall be concealed from compartments with seamless corners in all areas
Fuel fill access:
An access opening for the fuel fill installation shall be provided in the driver’s side wheel well area. The
fuel filling equipment will be installed by the final stage manufacturer
Left side body compartments:
Compartment L-1T
ƒ Left side forward compartment. Approximate dimensions: 35 ¼” w x 40 ¼” h x 20” d. Door
opening: 30 ¾” w x 36” h
ƒ Adjustable tracks installed on each side wall
Compartment L-2
ƒ Left side over wheel well compartment. Approximate dimensions: 43 ¼” w x 20 ¼” h x 20” d.
Door opening: 40 ¼” w x 16” h
ƒ Adjustable tracks installed on each side wall
Compartment L-3
ƒ Left side rear compartment. Approximate dimensions: 29 ¼” w x 40 ¼” h x 20” d. Door opening:
24 ¾” w x 36” h
ƒ Four (4) adjustable tracks installed, two (2) on each side wall
Right side body compartments:
Compartment R-1T
ƒ Right side forward compartment. Approximate dimensions: 35 ¼” w x 40 ¼” h x 20” d. Door
opening: 30 ¾” w x 36” h
ƒ Adjustable tracks installed on each side wall
Compartment R-2
ƒ Right side over wheel well compartment. Approximate interior dimensions: 72.7” w x 20 ¼” h x
20”d. Door opening: 68” w x 16” h
ƒ Adjustable tracks installed on each side wall
Compartment R-3
ƒ Right side rear compartment. Approximate dimensions: 27” w x 20” h x 20” d. Door opening: 23
½” w x 17” h
ƒ Four (4) adjustable tracks installed, two on each side wall
Rear compartment bed:
Compartment RR-1
ƒ Rear compartment shall be located above the frame rails: Dimensions: 51” w x 43” h x 104” d. Door
opening: 46” w x 40” h
ƒ Adjustable tracks installed on each side wall
Electrical wiring conduits:
Surface mounted conduit shall be installed in the body for routing the 12 volt and the 120/240 volt
Material and installation shall conform to applicable NFPA and SAE standards
Wiring shall be easily accessed through a removable cover
Body painting specifications:
Exterior and interior of the body as well as associated components requiring painting shall be finished
using the following procedure:
ƒ Composite material shall be sand blasted
ƒ Components are to be chemically cleaned on all surfaces
ƒ All surfaces are to be sanded to proper levels and all sanding residue removed
ƒ Any imperfections or defects shall be filled with premium body filler and sanded smooth
ƒ Top quality glaze applied over body filled areas and sanded
ƒ Components are to be primed with the paint manufacturer’s recommended primer
ƒ Entire primed surface shall be thoroughly sanded and inspected for any imperfections and properly
correct them
ƒ Apparatus body shall be cleaned with a wax and grease remover
ƒ Base coat/clear coats shall be applied following the paint manufacturer’s guidelines
Body shall be painted using a single color to match the cab primary color
Under body finish:
Under body shall be finished with black paint, RAL 9005 or equivalent
Interior compartment finish:
Interior wall, floor and ceiling surfaces of the body compartments shall be finished with Zolatone 20-72
industrial coating
Silver/gray speckle finish over a Zolatone basecoat primer
Top of body finish:
Top of body shall be finished with an aggressive non-slip industrial coating
Rear wheel fenderettes:
Polished stainless steel fenderettes shall be installed at each rear wheel opening and positioned outside
of the wheel well panel to cover the tire area that extends past the body
Fenderettes shall be secured with threaded fasteners
Fuel fill access:
Fire shop, or equivalent, stainless steel enclosure with hinged access door shall b installed in the
driver’s side wheel well
Rub rails:
The sides of the lower body area before and after the wheel well shall have 3” x 1.5” x .250” extruded
aluminum rub rails with end caps or angle corners
Rub rails shall have red and white DOT type reflective striping
Protective covering:
The front corners of the apparatus shall have a stainless steel protective covering installed
Door construction:
Six (6) GRP doors fabricated from fiberglass reinforced polyester shall be provided
Each GRP door shall have a stainless steel full height, piano style hinge with stainless steel rod
Stainless steel locking D-ring style handles with slam action single point hardware shall be provided for
each door
A spring loaded rod guide stay arm style device shall be provided on each door
Door depth shall align with the body sill depth that has an attaching flange and finishing flange
incorporated in the design
Low profile side and top seal
Magnetic door ajar system integrated in the handle and striker retainer block
Rear bumper, tow plates and rear step grating:
12” deep Plastisol Composites, or equivalent, step shall be provided and installed at the rear of the
Step shall be equipped with a multi-directional aggressive gripping surface and shall comply with NFPA
#1901 standards
Rear step and bumper assembly shall have 3” tow plates installed
Step shall feature a 3 point portable winch connection, one on each side and one at the rear
Handrail – rear step:
• Two (2) stainless steel non-slip handrails, approximately 36” long shall be provided and mounted on
the rear of the of the apparatus, one (1) on each side of the body
Equipment mounting:
• Adjustable 24” deep shelves
• Five (5) adjustable shelves constructed of smooth aluminum plates or composite material shall
be mounted in specified compartments with double bolt shelf brackets
• Each shelf shall have a broken front and rear edge.
• Location of shelving shall be:
♦ Compartment L1
♦ Compartment L2
♦ Compartment L3
♦ Compartment R2
♦ Compartment R3
12 Volt electrical specifications:
The following describes the low voltage electrical system on the apparatus including all panels, electrical
components, switches and relays, wiring harnesses and other electrical components. The apparatus
manufacturer shall conform to the latest Federal DOT standards and the applicable requirements of the NFPA
• Wiring shall be stranded copper or copper alloy conductors of a gauge rated to carry 125% of the
maximum current for which the circuit is protected
• Voltage drops shall not exceed 10% in all wiring from the power source to the using device
• Wiring and wiring harness and insulation shall be in conformance with applicable SAE and NFPA
standards. The wiring harness shall conform to SAE J-1128 and with GXL temperature properties
• Exposed wiring shall be run in a loom with a minimum 289° Fahrenheit rating
• Wiring looms shall be properly supported and attached to body members
• Electrical conductors shall be constructed in accordance with applicable SAE standards
• All wiring connections and terminations shall provide positive mechanical and electrical connections
and shall be installed in accordance with the device manufacturer’s instructions. When wiring passes
through metal panels electrical connections shall be with mechanical type fasteners and rubber
• Wiring between cab and body shall be split using Deutsche type connectors or enclosed in a terminal
• Connections shall be crimp-type with heat shrink tubing with insulated shanks. Weather resistant
connectors shall be provided throughout the system
• Electrical junction or terminal boxes shall be weather resistant and located away from water spray
• Automatic reset breakers and relays shall be housed in the main body junction panel
• There shall be no exposed electrical cabling, harnesses or terminal connections located in
compartments unless enclosed in an electrical junction box or covered with a removable electrical
panel. Wiring shall be secured in place and protected against heat, liquid contaminants and damage
and shall be uniquely identified at least every two (2) feet by color coding or permanent marking with a
circuit function code and identified on a reference chart or electrical wiring schematic per requirements
of applicable NFPA #1901 standards
• Low voltage over current protective devices shall be provided for the electrical circuits. Devices shall be
located in required terminal connection locations or weather resistant enclosures. Over current
protection devices shall be automatic reset type suitable for electrical equipment and meet SAE
• All electrical equipment, switches, relays, terminals and connectors shall have a direct current rating of
125% of maximum current for which the circuit is protected. Electro-magnetic interference
suppression shall be provided in the system as required in applicable SAE standards
Electrical system requirements:
The electrical system shall include the following:
• Electrical terminals in weather exposed areas shall have an non-conductive grease or spray applied. All
terminal plugs located outside of the cab or body shall be treated with a corrosion preventative
Electrical system requirements – continued:
All electrical wiring shall be placed in a protective loom or it shall be harnessed
Exposed connections shall be protected by heat shrink material and sealed connectors
Large fender washers shall be used when fastening equipment to the underside of the cab roof and all
holes made in the roof shall be caulked with silicone
Electrical components installed in exposed areas shall be mounted in a manner that will not allow
moisture to accumulate inside
A coil of wire must be provided behind an appliance to allow them to be pulled away from mounting
area for inspection and service work
All lights in a weather exposed area that have sockets shall have corrosion preventative compound
added to the socket terminal area
Warning lights shall be switched in the chassis cab with labeled rocker type switches located in an
accessible location. Individual rocker switches shall be provided only for lights exceeding the minimum
level of warning lights in either the stationary or moving modes. All electrical equipments switches
shall be appropriately identified as to their function and mounted on a switch panel in the cab. An
indicator light shall be provided to indicate when a circuit is energized.
A single warning light switch shall activate all required warning lights. The switch shall activate all
required warning lights. The switch shall allow the vehicle to respond to an emergency “calling for the
right of way”. When the parking brake is activated a “blocking the right of way” system shall be
automatically activated per NFPA #1901 requirements.
Electrical testing and certifications:
Upon completion of the vehicle and prior to delivery the apparatus shall be electrically tested. The electrical
testing, certifications and test results shall be submitted with delivery documentation per NFPA #1901
requirements. The following minimum testing shall be completed by the apparatus manufacturer:
• Reserve capacity test: the engine shall be started and kept running until the engine and engine
compartment temperatures stabilize at normal operating temperatures and the battery system is fully
charged. The engine shall be turned off and the minimum continuous electrical load shall be activated
for ten (10) minutes. All electrical loads shall be turned off prior to restarting the engine. The battery
system shall be capable of restarting the engine. Failure to restart the engine shall be considered a test
• Alternator performance test at idle: the minimum continuous electrical load shall be activated with the
engine running at idle speed. The engine temperature shall be stabilized at normal operating
temperature. The battery system shall be tested for the presence of battery discharge current. The
detection of battery discharge current shall be considered a test failure.
• Alternator performance test at full load: the total continuous electrical load shall be activated with the
engine running up to the manufacturer’s governed speed. The test duration shall be a minimum of two
(2) hours. Activation of the load management system shall be permitted during the test. An alarm
sounded by excessive battery discharge as detected by the system required in NFPA #1901 standard or a
system voltage of less than 11.7 volts dc for a 12 volt system for more than two (2) minutes shall be
considered a test failure.
Electrical testing and certifications – continued:
Low voltage alarm test: following the completion of the above tests the engine shall be shut off. The
total continuous electrical load shall be activated and continue to be applied until the excessive battery
discharge alarm activates. The battery voltage shall be measured at the battery terminals. With the
load still applied, a reading of less than 11.7 volts dc for a 12 volt system shall be considered a test
failure. The battery system shall then be able to restart the engine. Failure to restart the engine shall be
considered a test failure
Console and Switch Panel:
A custom fabricated electrical console and enclosure shall be located between the driver’s and passenger’s seat
and shall include six (6) control switches in a removable panel. Two (2) fire department supplied radio heads
shall also be accommodated in this space. Construction shall be of smooth aluminum or composite material
with a hinged top and shall house cab mounted electrical switching devices and equipment as required.
The console shall accommodate the following:
• Tow (2) customer supplied radios
• Two (2) hand lights with chargers
• One (1) customer supplied radio head
• Siren controller
• Bin with cover for storage of crew personal items
Battery switch – master disconnect:
Battery disconnect rocker switch controlling the 12 volt power supply from the battery system shall be
located conveniently to the driver
A light indicating that the master switch is on shall be included
Battery charger:
A high output automatic battery charger, Kussmaul Autocharge 1000 model #091-56-12, or equivalent
shall be provided
Battery charger shall be wired to the 12 volt battery system
Battery charger shall be wired to the specified shore power receptacle
120 Volt shore power receptacle:
An “auto eject” shore power receptacle, Kussmaul model 091-55xx -120 20 amp, or equivalent shall be
provided with hinged weatherproof cover and enclosure
Shore power plug shall be “ejected” when the chassis’ engine starter is engaged and the receptacle shall
be wired to any 120 volt A/C equipment requiring shore power
Receptacle shall be located on the driver’s side rear of the chassis (rear of crew cab door)
Identification lights:
All LED identification lights shall be installed on the vehicle as required by applicable DOT highway
• Two (2) tail, stop, turn and back up light assemblies shall be installed at the rear of the body and shall
consist of:
ƒ Clear tail and stop lights with red LEDs – T40-RCFT-1 or equivalent
ƒ Clear turn signals with amber LEDs – T40-ACFT-1 or equivalent
ƒ One (1) clear LED dome light with an on/off switch shall be mounted in the cab ceiling – E13W300-1 or equivalent
ƒ One (1) clear/red LED dome light with on/off switch shall be mounted in the cab ceiling – E11DS01-1 or equivalent
ƒ Four (4) clear LED ground lights installed under the cab step area in compliance with NFPA #1901
ƒ Two (2) LED step lights with clear lens shall be installed at the rear step of the apparatus wired to
the parking brake circuit – E96-WS00-1 or equivalent
ƒ Six (6) clear LED scene lights shall be installed. Lights shall be operated by an on-cab console
switch. Location: two (2) on each side of body and two (2) at the rear body panel. Fire Research
Corp. or equivalent
ƒ Automatic switches for each scene light shall be installed to activate all scene lights when a
compartment door is opened. The rear scene lights shall activate automatically when the
transmission is in reverse
ƒ Seven (7) compartment’s equipped with T-Systems or equivalent, trip LED lights installed on one
side of door opening. Lights shall be integrated into the roll-up door track with light turning on
with door opening
ƒ Each exterior compartment light shall be automatically controlled by a door activated on/off switch
ƒ A flashing LED light with red lens indicating “Door Open”, or equipment operation light shall be
installed on cab dash
ƒ An automatic electric back-up alarm shall be wired to the back-up light circuit and mounted under
the rear of the apparatus body. Ecco Model SA-907 “Smart Alarm” or equivalent
Warning lights and sirens:
One (1) electronic siren shall be mounted in the cab. The unit shall have an electronic air horn, wail,
yelp, hi-lo siren and hard wired microphone
Two (2) 100-watt chrome plated speakers shall be installed and wired to the electronic sire located in
the cab
Zone A – Upper lightbar
ƒ One (1) Code 3 model #2147 NFPA1 light shall be installed on the cab roof. The LED X2100 series
lightbar shall be 47” l and shall include fourteen (14) red LED single modules. Take down lights
shall be included, wired to wig/wag
Zone A – Lower front warning lights
ƒ Two (2) Code 3 model #45R LED lights shall be installed in the lower front of the cab. Lights shall
be 3” x 7” and equipped with a red lens
Zone B and D – Lower cab intersection lights
ƒ Two (2) Code 3 LED lights shall be installed, one (1) on each side of the front bumper. Lights shall
be 2” x 5” and have a red lens
Warning lights and sirens – continued:
Zone B and D – Lower mid-body warning lights
ƒ Two (2) Code 3 LED warning lights shall be installed, one (1) on each side on the lower side of the
mid-body. The lights shall be 4” x 6”and have a red lens
Zone B and D – Upper side front warning lights
ƒ Two (2) Code 3 LED warning lights shall be installed, one (1) on each side on the upper front of the
body. The lights shall be 2” x 5” and shall have a red lens
Zone B and D – Upper side rear warning lights
ƒ Two (2) Code 3 LED warning lights shall be installed, one (1) on each side on the upper side of the
rear body. The lights shall be 2” x 5” and shall have a red lens
Zone C – Upper rear warning lights
ƒ Two (2) Code 3 LED warning lights shall be installed, one (1) each side on the upper corners of the
rear body. The lights shall be 7” x 9” and shall have a red lens on the right side and an amber lens
on the left side
Zone C – Lower rear warning lights
ƒ Two (2) Code 3 LED warning lights shall be installed, one (1) each side on the lower corners of the
rear body. The lights shall be 7” x 9” and shall have a red lens
Air System:
SCBA cylinder storage modules
ƒ Performance Advantage #CM600 cylinder mate SCBA storage unit constructed entirely from noncorrosive materials. Automatically adjusts to contain cylinders with either 30 or 45 minute ratings
ƒ Units shall be designed for either horizontal or vertical installation
ƒ Unit shall be designed to avoid friction and damage to high pressure cylinders and include a high
strength “push to release” retention strap
9 Cylinder type and model: varies
9 Quantity of cylinders: 24
9 Location shall be in compartment #L1 and #R1
Engine driven high pressure compressor and purification system
ƒ Bauer model #H13G and H13D, 6000 psi service, or equivalent, system shall be supplied on a steel
frame designed for both the static and dynamic loads of the system
ƒ Arrangement of components on the frame shall permit unrestricted coding air flow to the
compressor and prime mover
ƒ Units shall have compressor and engine arranged in a horizontal design
ƒ System shall be designed for operation in ambient temperatures ranging between 40° F and 115° F
ƒ Installation shall not required a special foundation
ƒ All piping and tubing shall be properly supported and protected to prevent damage from vibration
ƒ All instrument tubing shall be 300 series stainless steel
ƒ System shall be warranted free from defects in material and workmanship for eighteen (18) months
from date of shipment or twelve (12) months from startup, whichever expires first. The warranty
shall not impose limitations on the system’s accumulated operating hours during the warranty
ƒ Air cooled, oil lubricated, four stage three cylinder, reciprocating compressor rated for continuous
duty at the maximum working pressure without the need for auxiliary fans or cool down cycles
ƒ Crank case shall be cast of a high strength aluminum alloy
Air system – continued:
Crank shaft shall be single piece forged steel construction, supported in the crank case by three
long-life roller bearings
ƒ The connecting rods shall be single piece design constructed of high strength aluminum alloy
ƒ Each connecting rod shall incorporate a roller bearing at the crank end and a needle bearing at the
pin end
ƒ Pistons shall be constructed of heavy duty aluminum alloy
ƒ Piston rings on the second and third stage are cast iron; first and fourth stage rings shall be high
strength polymide
ƒ Final stage shall incorporate a free floating, heavy duty aluminum alloy piston driven by a guide
piston and third stage discharge pressure
ƒ Cylinders shall be cast iron construction with deep cooling fins on the external surface. Cylinders
shall be arranged in a “W” configuration with each cylinder located directly in the cooling fan’s blast
ƒ Cylinders shall be removable from the crank case
ƒ Compressor’s flywheel shall be aluminum alloy with a multi-wing, high velocity cooling fan
ƒ An inter-stage cooler shall be provided after each stage of compression and an after cooler shall be
provided after the final stage of compression
ƒ Cooler assemblies shall be individually detachable from the compressor, located directly in the
cooling fan’s blast and made of stainless steel
ƒ The after cooler shall cool the air to within 18° F of ambient temperature
ƒ Cool-down cycle shall not be required prior to stopping the compressor
ƒ A separator shall be supplied after each stage of compression, excluding the first stage and a
coalescing separator shall be supplied after the final stage of compression
ƒ An automatic condensate drain (ACD) system shall be supplied for all of the separators
ƒ Adjustable drain timers shall be factory pre-set to drain the separators approximately every fifteen
(15) minutes for approximately six (6) seconds
ƒ ACD system shall unload the compressor on shut down for unloaded restart
ƒ Exhaust muffler shall be supplied
ƒ The condensate reservoir shall have a high liquid level indication system to provide system
shutdown and to alert the operator that the condensate reservoir is at capacity
ƒ Manually operated valves shall be supplied to override the automatic operation of the ACD system
ƒ Compressor shall be lubricated by a low pressure lubrication system incorporating a gear driven,
low pressure oil pump, easily replaceable oil filtration element and oil pressure regulator
ƒ Sight glass for checking the oil level shall be provided
ƒ Oil drain for the compressor shall be piped to the outside of the frame
ƒ Compressor shall be equipped with an inlet filler with replaceable particulate element
Prime Mover and V-Belt Drive
ƒ Engine driven units shall be supplied with electric start, electronically actuated clutch and speed
control solenoid
ƒ Enclosure shall be provided for battery
ƒ H13-G unit shall have a 13 hp gasoline engine. Engine shall be a single cylinder, four cycle, aircooled with overhead valves
ƒ H13-D shall have a water cooled 18 hp diesel engine
ƒ Compressor and prime mover shall be mounted on a common base that is vibration isolated from
the system’s main frame
ƒ Power from the prime mover shall be transmitted to the compressor by a v-belt drive
ƒ Engine driven units shall be supplied with a sliding base
ƒ V-belt drive shall be guarded
ƒ Rotation arrows shall be affixed on the compressor
Air system – continued:
Electrical Control and Instrument Panel
ƒ Engine control center shall include a PLC controller
ƒ Electrical panel shall be built in compliance to UL’s Industrial Control Panel Custom Builders
Program and shall be affixed with a UL label
ƒ PLC compressor control system shall consist of a programmable logic controller for monitoring
protection and control of standard compressor systems
ƒ NEMA 4 enclosure
ƒ On/off switch
ƒ Emergency stop
ƒ Final air pressure shutdown
ƒ Warning and alarm indicator lights
9 Lamps shall be a minimum 22mm diameter
9 Lamp test function built-in
9 Lamps will flash code representing fault
ƒ Built-in overtime timer set at five (5) hours with optional times available
ƒ Final separator counter warning and alarm function
ƒ Full support of SECURUS warning and alarm function
ƒ Full support of CO monitor alarm functions
ƒ UL listed panel
ƒ Non-resettable hour meter for recording number of compressor operating hours shall be installed in
the instrument panel
ƒ Compressor oil pressure shall be monitored by a pressure switch and pressure gauge installed in the
instrument panel
ƒ Compressor shall shut down and a fault light illuminate if the compressor’s oil pressure drops below
the factory pre-set value during operation
ƒ Oil pressure switch shall be by-passed during start-up
ƒ Temperature switch shall be supplied on the discharge line of the final stage of compression.
Compressor shall shut down and fault light illuminate if the final stage discharge temperature
exceeds the tamper-proof set point during operation
ƒ Low oil pressure and high air pressure air shutdown switches shall be equipped with DIN type
ƒ All wiring shall be encapsulated within a split corrugated type loom. Each wire end connection shall
be crimped and numbered
ƒ All fault light shall be installed on the instrument panel, shall be red in color, and labeled
ƒ All instrument panel mounted pressure gauges shall be liquid filled and 2 ½” in diameter
Purification System
ƒ Purification system shall purify high pressure air to a quality that meets or exceeds the following
9 CGA Pamphlet G-7, Compressed Air for Human Respiration
9 ANSI/CGA G-7.1, Commodity Specification for Air, Grade E
9 All other recognized standards for breathing air
ƒ Purification shall be achieved by mechanical separation of condensed oil and water droplets,
adsorption of vaporous water by a desiccant, absorption of oil vapor and elimination of noxious
odors by activated carbon and conversion of carbon monoxide to respirable levels of carbon dioxide
by catalyst
ƒ The high pressure purification chambers shall have a working pressure of 6000 PSIG
ƒ System shall utilize replaceable cartridges
ƒ Replacement of the cartridges can be done without disconnecting system piping
Air system – continued:
The system shall not operate without cartridges installed or with improperly installed cartridges
A bleed valve shall be provided to vent the purification system
A pressure maintaining valve and a check valve shall be supplied downstream of the purification
ƒ A check valve shall be supplied between the separator on the compressor’s discharge line and the
purification system
ƒ The purification system shall include Bauer’s Securus Electronic Moisture Monitor System
ƒ A sensor shall be located in the Securus cartridge for direct monitoring of moisture level
ƒ A display module shall be supplied to indicate the status of the cartridge
ƒ Moisture monitoring system shall warn the operator in advance of the impending saturation of the
ƒ System shall shut down automatically if cartridge is not changed within the warning period and
shall not be capable of restarting until the cartridge is replaced
ƒ Moisture monitoring system shall be of a fail-safe design
ƒ An immediate fault shutdown shall occur if the electrical contact between the display module and
sensor become disconnected
ƒ No override shall be supplied for the moisture monitor
Testing and System Manufacturer Identification
ƒ The system shall be tested by the manufacturer prior to shipment. A copy of the test report shall be
provided to the County.
ƒ Manufacturer’s nameplate shall be affixed to the system and shall contain the following
9 Manufacturer’s name
9 Model #
9 Serial #
9 Compressor block #
9 System operating pressure
9 Compressor operating speed
9 Compressor capacity and charging rate
9 Motor horsepower
9 Voltage
9 Frequency
9 Amperage
9 Date of manufacture
A documentation package shall be supplied with the system and shall include, at a minimum, the
following items:
ƒ Operator’s instruction and maintenance manual which shall include the detailed outline of the
operation instructions, illustrated drawings for the compressor block and all system components,
complete parts listing for all illustrated components and warnings and safety precautions.
ƒ Recommended spare parts list
ƒ Warranty information
ƒ Warranty registration form
The following shall be offered by the manufacturer as accessories to the system:
ƒ Purification upgrades
ƒ Carbon monoxide monitor with calibration kit
ƒ Audible alarm for safety shut downs
Air system – continued:
ƒ Storage systems
ƒ Fill stations
Reference Outline Dimension Drawing:
ƒ Provided for:
9 H13-G-ASY 0558
9 H13-D-ASY 0937
DOT Air Cylinders:
ƒ Four (4) DOT 6000 psi air cylinders shall be installed and piped to the air system. Cylinders shall
be 509 cu. ft. DOT, 70” L x 9.5” diameter
Horizontal Mounting Air Storage:
ƒ Nine (9) air pressure cylinders shall be securely mounted in a specified compartment in a steel
mounting rack with an adjustable tightening system
ƒ Cylinders shall not be subject to damage, wear or vibration
High Pressure Breathing Air Reels:
ƒ Hannay 1500 Series, or equivalent, 12 volt electric rewind high pressure air hose shall be installed.
Reel color: red. Reel location:
9 12 volt rewind electrical supply shall be wired directly from the chassis battery system with
heavy duty stranded copper cable with guarded finger type rewind button. The piping to the air
reel system shall be through high pressure, 6000 psi hose with threaded couplings from air
storage system
ƒ Air control panel shall have the following:
9 One (1) quarter turn shut-off valve to isolate air reel
9 One (1) 2 ½” diameter upstream pressure gauge
9 One (1) adjustable pressure regulator
9 One (1) 2 ½” diameter downstream pressure gauge
9 One (1) check valve in supply line
9 Label indicating high pressure breathing air and pressure range
ƒ 200’ length high pressure (5000 psi rating) breathing air hose with quick connect fittings shall be
provided on the air reel
ƒ One (1) Hannay four-way style stainless steel roller assembly shall be installed
ƒ Hannay orange ball stop assembly, installed on air hose, shall be provided
Rear Trailer Hitch
ƒ One (1) class 3 type trailer hitch, rated at approximately 10,000 lbs. shall be installed at the rear of
the apparatus attached to the body sub-frame assembly
ƒ Hitch shall include frame, receiver insert, slide-in ball mount with a 1 ¾” ball, a 5/8” hitch pin and
6-pin cable
ƒ Wiring shall be provided at the rear of the apparatus. A 12-volt electrical connector shall be wired to
the chassis stop, running and turn lights, and electrical trailer brakes
Lettering and Striping:
All lettering and striping shall be approved by the County prior to application to the vehicle.
Gold leaf lettering, bordered in black and enclosed in clear mylar shall be placed on the cab and the
body as directed by the County. A total quantity of fifty (50) 4” letters will be needed
Reflective striping shall be provided for the front and sides of the vehicle. The striping shall be 5” x 1”
wide 3M brand Scotchlite reflective multi-stripe. There shall be a 1” gap between each of the stripes.
The striping shall be placed up to 60” above ground level and shall conform to 2009 NFPA #1901
reflectivity requirements. The reflective striping shall be applied to a minimum of 50% of the perimeter
length on each side and 50% of the perimeter width of the front of the vehicle.
The outer rear panels of the body shall have Reflexite® brand 6” wide reflective red and amber striping
installed over 100% of available area. The Chevron style stripe shall be applied at a 45° angle pointing
towards the center upper portion of the rear panel.
NFPA and DOT Required Highway Safety Equipment:
The apparatus shall be equipped with a NFPA and DOT required highway safety kit as follows:
ƒ One (1) set of three (3) dual faced triangular warning flares with foldaway bases and storage cases
ƒ One (1) 2.5# ABC dry chemical fire extinguisher with vehicle mounting bracket
ƒ Six (6) 24” high reflective traffic cones
Miscellaneous Additional Items:
Two (2) rubber wheel chocks provided on the apparatus and two (2) wheel chock mounting brackets
installed under the body
One (1) 24-unit first aid kit shall be provided
One (1) Audiovox ACA 200W, or equivalent, rear vision color camera system. The system shall include
a camera and color screen, wired to activate with the back-up circuit
Vehicle Year:
Bid Price:
Bid Price (written in words)
days a/r/o
Company Name:
Remittance Address:
(if different than mailing address)
During the performance of this contract, (the contractor) hereby agrees as follows:
The contractor will not discriminate against any employee or applicant for employment because of race, creed, color or
national origin, and will take affirmative action to insure that they are afforded equal employment opportunities without
discrimination because of race, color, creed, ethnicity, Vietnam-era veteran status, disabled veteran, marital status,
disability, national origin, or status as an ex-offender. Such action shall be taken with reference, but not be limited, to:
recruitment, employment, job assignment, promotion, upgrading, demotion, transfer, layoff or termination, rates of pay
or other forms of compensation, and selection for training or retraining, including apprenticeship and on-the-job training.
The contractor will send to each labor union or representative of workers with which he has or is bound by a collective
bargaining or other agreement or understanding, a notice, to be provided by the State Commissioner for Human Rights,
advising such labor union or representative of the contractor's agreement under clauses (a) through (f) hereinafter called
"non-discrimination clauses". If the contractor was directed to do so by the contracting agency as part of the bid or
negotiation of this contract, the contractor shall request such labor union or representative to furnish him with as written
statement that such labor union or representative either will affirmatively cooperate, within the limits of its legal and
contractual authority, in the implementation of the policy and provisions of these non-discrimination clauses or that it
consents and agrees that recruitment, employment and the terms and conditions of employment under this contract shall
be in accordance with the purposes and provisions of these non-discrimination clauses. If such labor union or
representative fails or refuses to comply with such a request that it furnish such a statement, the contractor shall promptly
notify the State Commission for Human Rights of such failure or refusal.
The contractor will post and keep posted in conspicuous places, available to employees and applicants for employment,
notices to be provided by the State Commission for Human Rights setting forth the substance of the provisions of clauses
(a) and (b) and such provisions of the State's and local Tompkins County Laws against discrimination as the State
Commission for Human Rights shall determine.
The contractor will state, in all solicitations or advertisements for employees placed by or on behalf of the contractor, that
all qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed,
color or national origin.
The contractor will comply with the provisions of Sections 291-299 of the Executive Law and the Civil Rights Law, will
furnish all information and reports deemed necessary by the State Commission for Human Rights under these nondiscrimination clauses and such sections of the Executive Law, and will permit access to his books, records and accounts
by the State Commission for Human Rights, the Attorney General and the Industrial Commissioner for purposes of
investigation to ascertain compliance with these non-discrimination clauses and such sections of the Executive Law and
Civil Rights Law.
This contract may be forthwith cancelled, terminated or suspended, in whole or in part, by the contracting agency upon
the basis of a finding made by the State Commission for Human Rights that the Contractor may be declared ineligible for
future contracts made by or on behalf of the State or a public authority or agency of the State, until he satisfies the State
Commission for Human Rights that he has established and is carrying out a program in conformity with the provisions of
these non-discrimination clauses. Such finding shall be made by the State Commission for Human Rights after
conciliation efforts by the Commission have failed to achieve compliance with these non-discrimination clauses and after
a verified complaint has been filed with the Commission, notice thereof has been given to the Contractor and opportunity
has been afforded him to be heard publicly before three members of the Commission. Such sanctions may be imposed
and remedies invoked independently of or in addition to sanctions and remedies otherwise provided by law. The
Contractor will include the provisions of clauses (a) through (f) in every subcontract or purchase order in such a manner
that such provisions be performed within the State of New York. The Contractor will take such action in enforcing such
provisions of such subcontract or purchase order as the contracting agency may direct, including sanctions or remedies
for non-compliance. If the Contractor becomes involved in or is threatened with litigation with a subcontractor or vendor
as a result of such direction by the contracting agency, the Contractor shall promptly so notify the Attorney General,
requesting him to intervene and protect the interests of the State of New York.
By submission of this bid/proposal, each bidder/proposer and each person signing on behalf of any
bidder/proposer certifies, and in the case of a joint bid/proposal each party thereto certifies as to its own
organization, under penalty of perjury, that to the best of his/her/their knowledge and belief:
The prices in this bid/proposal have been arrived at independently without collusion, consultation,
communication, or agreement, for the purpose of restricting competition, as to any matter relating to
such prices with any other bidder/proposer or with any competitor;
Unless otherwise required by law, the prices that have been quoted in this package have not been
knowingly disclosed by the bidder/proposer prior to opening, directly or indirectly, to any other
bidder/proposer or to any competitor; and
No attempt has been made or will be made by the bidder/proposer to induce any other person,
partnership, or corporation to submit or not to submit a bid/proposal for the purpose of restricting
Name of Bidder/Proposer
Signature and Title of Signer
A bid/proposal shall not be considered for award nor shall any award be made where (a) 1, 2 and 3 above have not been
complied with; provided, however, that if in any case the bidder/proposer cannot make the foregoing certification, the
bidder/proposer shall so state and shall furnish with the bid/proposal a signed statement that sets forth in detail the
reason(s) therefore. Where (a) 1, 2, and 3 above have not been complied with, the bid/proposal shall not be considered
for award nor shall any award be made unless the head of the purchasing unit of the political subdivision, public
department, agency or official thereof to which the bid/proposal is made, or his designee, determines that such disclosure
was not made for the purpose of restricting competition.
The fact that a bidder/proposer (a) has published price lists, rates or tariffs covering items being procured, (b) has
informed prospective customers of proposed or pending publication of new or revised price lists for such items, or (c) has
sold the same items to other customers at the same prices being bid/proposed, does not constitute, without more, a
disclosure within the meaning of subparagraph (a) 1.
Please check off and sign for items below and submit this required sheet with your bid packet; the bid may be
rejected if the required documents are not included with the bid. Please note that by signing below the bidder
is certifying that all information provided herein is true and correct to the best of their knowledge.
Bid Sheet completed
Non-Collusive certificate completed
Anti-Discrimination clause completed
Proof of insurance coverage in amounts required by specification
signed by insurance agent enclosed
Addenda (if issued) received
List Addendum # and dates
Insurance Binder completed
Name/Title of Authorized Person Submitting Bid
Firm or Corporation Making Bid
Address (street, city, state, zip)
Federal ID #
Accounts Payable Address (if different than above)
Signature of Authorized Person Submitting Bid
Request for Taxpayer
Identification Number and Certification
(Rev. October 2007)
Department of the Treasury
Internal Revenue Service
Give form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name, if different from above
Check appropriate box:
Individual/Sole proprietor
Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership)
Other (see instructions)
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Social security number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Employer identification number
Part II
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Signature of
U.S. person ©
Date ©
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the withholding tax on
foreign partners’ share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester’s form if it is
substantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
● An individual who is a U.S. citizen or U.S. resident alien,
● A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
● An estate (other than a foreign estate), or
● A domestic trust (as defined in Regulations section
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners’ share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
● The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X
(Rev. 10-2007)
Form W-9 (Rev. 10-2007)
● The U.S. grantor or other owner of a grantor trust and not the
trust, and
● The U.S. trust (other than a grantor trust) and not the
beneficiaries of the trust.
4. The IRS tells you that you are subject to backup
withholding because you did not report all your interest and
dividends on your tax return (for reportable interest and
dividends only), or
Foreign person. If you are a foreign person, do not use Form
W-9. Instead, use the appropriate Form W-8 (see Publication
515, Withholding of Tax on Nonresident Aliens and Foreign
5. You do not certify to the requester that you are not subject
to backup withholding under 4 above (for reportable interest and
dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup
withholding. See the instructions below and the separate
Instructions for the Requester of Form W-9.
Also see Special rules for partnerships on page 1.
Nonresident alien who becomes a resident alien. Generally,
only a nonresident alien individual may use the terms of a tax
treaty to reduce or eliminate U.S. tax on certain types of income.
However, most tax treaties contain a provision known as a
“saving clause.” Exceptions specified in the saving clause may
permit an exemption from tax to continue for certain types of
income even after the payee has otherwise become a U.S.
resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an
exemption from U.S. tax on certain types of income, you must
attach a statement to Form W-9 that specifies the following five
1. The treaty country. Generally, this must be the same treaty
under which you claimed exemption from tax as a nonresident
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that
contains the saving clause and its exceptions.
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such
failure unless your failure is due to reasonable cause and not to
willful neglect.
Civil penalty for false information with respect to
withholding. If you make a false statement with no reasonable
basis that results in no backup withholding, you are subject to a
$500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal
penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in
violation of federal law, the requester may be subject to civil and
criminal penalties.
4. The type and amount of income that qualifies for the
exemption from tax.
Specific Instructions
5. Sufficient facts to justify the exemption from tax under the
terms of the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows
an exemption from tax for scholarship income received by a
Chinese student temporarily present in the United States. Under
U.S. law, this student will become a resident alien for tax
purposes if his or her stay in the United States exceeds 5
calendar years. However, paragraph 2 of the first Protocol to the
U.S.-China treaty (dated April 30, 1984) allows the provisions of
Article 20 to continue to apply even after the Chinese student
becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of
the first protocol) and is relying on this exception to claim an
exemption from tax on his or her scholarship or fellowship
income would attach to Form W-9 a statement that includes the
information described above to support that exemption.
If you are a nonresident alien or a foreign entity not subject to
backup withholding, give the requester the appropriate
completed Form W-8.
If you are an individual, you must generally enter the name
shown on your income tax return. However, if you have changed
your last name, for instance, due to marriage without informing
the Social Security Administration of the name change, enter
your first name, the last name shown on your social security
card, and your new last name.
What is backup withholding? Persons making certain payments
to you must under certain conditions withhold and pay to the
IRS 28% of such payments. This is called “backup withholding.”
Payments that may be subject to backup withholding include
interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, and
certain payments from fishing boat operators. Real estate
transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments
you receive if you give the requester your correct TIN, make the
proper certifications, and report all your taxable interest and
dividends on your tax return.
Payments you receive will be subject to backup
withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II
instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect
If the account is in joint names, list first, and then circle, the
name of the person or entity whose number you entered in Part I
of the form.
Sole proprietor. Enter your individual name as shown on your
income tax return on the “Name” line. You may enter your
business, trade, or “doing business as (DBA)” name on the
“Business name” line.
Limited liability company (LLC). Check the “Limited liability
company” box only and enter the appropriate code for the tax
classification (“D” for disregarded entity, “C” for corporation, “P”
for partnership) in the space provided.
For a single-member LLC (including a foreign LLC with a
domestic owner) that is disregarded as an entity separate from
its owner under Regulations section 301.7701-3, enter the
owner’s name on the “Name” line. Enter the LLC’s name on the
“Business name” line.
For an LLC classified as a partnership or a corporation, enter
the LLC’s name on the “Name” line and any business, trade, or
DBA name on the “Business name” line.
Other entities. Enter your business name as shown on required
federal tax documents on the “Name” line. This name should
match the name shown on the charter or other legal document
creating the entity. You may enter any business, trade, or DBA
name on the “Business name” line.
Note. You are requested to check the appropriate box for your
status (individual/sole proprietor, corporation, etc.).
Exempt Payee
If you are exempt from backup withholding, enter your name as
described above and check the appropriate box for your status,
then check the “Exempt payee” box in the line following the
business name, sign and date the form.
Form W-9 (Rev. 10-2007)
Generally, individuals (including sole proprietors) are not exempt
from backup withholding. Corporations are exempt from backup
withholding for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should
still complete this form to avoid possible erroneous backup
The following payees are exempt from backup withholding:
1. An organization exempt from tax under section 501(a), any
IRA, or a custodial account under section 403(b)(7) if the account
satisfies the requirements of section 401(f)(2),
Part I. Taxpayer Identification
Number (TIN)
The chart below shows types of payments that may be
exempt from backup withholding. The chart applies to the
exempt payees listed above, 1 through 15.
Enter your TIN in the appropriate box. If you are a resident
alien and you do not have and are not eligible to get an SSN,
your TIN is your IRS individual taxpayer identification number
(ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may
enter either your SSN or EIN. However, the IRS prefers that you
use your SSN.
If you are a single-member LLC that is disregarded as an
entity separate from its owner (see Limited liability company
(LLC) on page 2), enter the owner’s SSN (or EIN, if the owner
has one). Do not enter the disregarded entity’s EIN. If the LLC is
classified as a corporation or partnership, enter the entity’s EIN.
Note. See the chart on page 4 for further clarification of name
and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one
immediately. To apply for an SSN, get Form SS-5, Application
for a Social Security Card, from your local Social Security
Administration office or get this form online at You
may also get this form by calling 1-800-772-1213. Use Form
W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Application for
Employer Identification Number, to apply for an EIN. You can
apply for an EIN online by accessing the IRS website at and clicking on Employer Identification
Number (EIN) under Starting a Business. You can get Forms W-7
and SS-4 from the IRS by visiting or by calling
1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN,
write “Applied For” in the space for the TIN, sign and date the
form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily
tradable instruments, generally you will have 60 days to get a
TIN and give it to the requester before you are subject to backup
withholding on payments. The 60-day rule does not apply to
other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to
the requester.
Note. Entering “Applied For” means that you have already
applied for a TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign owner
must use the appropriate Form W-8.
IF the payment is for . . .
THEN the payment is exempt
for . . .
Part II. Certification
Interest and dividend payments
All exempt payees except
for 9
Broker transactions
Exempt payees 1 through 13.
Also, a person registered under
the Investment Advisers Act of
1940 who regularly acts as a
Barter exchange transactions
and patronage dividends
Exempt payees 1 through 5
Payments over $600 required
to be reported and direct
sales over $5,000
Generally, exempt
1 through 7
2. The United States or any of its agencies or
3. A state, the District of Columbia, a possession of the United
States, or any of their political subdivisions or instrumentalities,
4. A foreign government or any of its political subdivisions,
agencies, or instrumentalities, or
5. An international organization or any of its agencies or
Other payees that may be exempt from backup withholding
6. A corporation,
7. A foreign central bank of issue,
8. A dealer in securities or commodities required to register in
the United States, the District of Columbia, or a possession of
the United States,
9. A futures commission merchant registered with the
Commodity Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year under
the Investment Company Act of 1940,
12. A common trust fund operated by a bank under section
13. A financial institution,
14. A middleman known in the investment community as a
nominee or custodian, or
15. A trust exempt from tax under section 664 or described in
section 4947.
See Form 1099-MISC, Miscellaneous Income, and its instructions.
However, the following payments made to a corporation (including gross
proceeds paid to an attorney under section 6045(f), even if the attorney is a
corporation) and reportable on Form 1099-MISC are not exempt from
backup withholding: medical and health care payments, attorneys’ fees, and
payments for services paid by a federal executive agency.
To establish to the withholding agent that you are a U.S. person,
or resident alien, sign Form W-9. You may be requested to sign
by the withholding agent even if items 1, 4, and 5 below indicate
For a joint account, only the person whose TIN is shown in
Part I should sign (when required). Exempt payees, see Exempt
Payee on page 2.
Signature requirements. Complete the certification as indicated
in 1 through 5 below.
1. Interest, dividend, and barter exchange accounts
opened before 1984 and broker accounts considered active
during 1983. You must give your correct TIN, but you do not
have to sign the certification.
2. Interest, dividend, broker, and barter exchange
accounts opened after 1983 and broker accounts considered
inactive during 1983. You must sign the certification or backup
withholding will apply. If you are subject to backup withholding
and you are merely providing your correct TIN to the requester,
you must cross out item 2 in the certification before signing the
Form W-9 (Rev. 10-2007)
3. Real estate transactions. You must sign the certification.
You may cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you
do not have to sign the certification unless you have been
notified that you have previously given an incorrect TIN. “Other
payments” include payments made in the course of the
requester’s trade or business for rents, royalties, goods (other
than bills for merchandise), medical and health care services
(including payments to corporations), payments to a
nonemployee for services, payments to certain fishing boat crew
members and fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. Mortgage interest paid by you, acquisition or
abandonment of secured property, cancellation of debt,
qualified tuition program payments (under section 529), IRA,
Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your
correct TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account:
1. Individual
2. Two or more individuals (joint
3. Custodian account of a minor
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
trust (grantor is also trustee)
b. So-called trust account that is
not a legal or valid trust under
state law
5. Sole proprietorship or disregarded
entity owned by an individual
Give name and SSN of:
The individual
The actual owner of the account or,
if combined funds, the first
individual on the account
The minor
The grantor-trustee
The actual owner
The owner
Give name and EIN of:
For this type of account:
6. Disregarded entity not owned by an
7. A valid trust, estate, or pension trust
8. Corporate or LLC electing
corporate status on Form 8832
9. Association, club, religious,
charitable, educational, or other
tax-exempt organization
10. Partnership or multi-member LLC
11. A broker or registered nominee
12. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
The owner
Legal entity
The corporation
The organization
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal
information such as your name, social security number (SSN), or
other identifying information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get
a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
● Protect your SSN,
● Ensure your employer is protecting your SSN, and
● Be careful when choosing a tax preparer.
Call the IRS at 1-800-829-1040 if you think your identity has
been used inappropriately for tax purposes.
Victims of identity theft who are experiencing economic harm
or a system problem, or are seeking help in resolving tax
problems that have not been resolved through normal channels,
may be eligible for Taxpayer Advocate Service (TAS) assistance.
You can reach TAS by calling the TAS toll-free case intake line
at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishing
schemes. Phishing is the creation and use of email and
websites designed to mimic legitimate business emails and
websites. The most common act is sending an email to a user
falsely claiming to be an established legitimate enterprise in an
attempt to scam the user into surrendering private information
that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails.
Also, the IRS does not request personal detailed information
through email or ask taxpayers for the PIN numbers, passwords,
or similar secret access information for their credit card, bank, or
other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to You may also report
misuse of the IRS name, logo, or other IRS personal property to
the Treasury Inspector General for Tax Administration at
1-800-366-4484. You can forward suspicious emails to the
Federal Trade Commission at: or contact them at or 1-877-IDTHEFT(438-4338).
Visit the IRS website at to learn more about
identity theft and how to reduce your risk.
The partnership
The broker or nominee
The public entity
List first and circle the name of the person whose number you furnish. If only one person
on a joint account has an SSN, that person’s number must be furnished.
Circle the minor’s name and furnish the minor’s SSN.
You must show your individual name and you may also enter your business or “DBA”
name on the second name line. You may use either your SSN or EIN (if you have one),
but the IRS encourages you to use your SSN.
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN
of the personal representative or trustee unless the legal entity itself is not designated in
the account title.) Also see Special rules for partnerships on page 1.
Note. If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest,
dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S.
possessions to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal
nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.
You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.