HELIBASE CRASH RESCUE INSPECTION FORM

+-------------------------+---------------------+-------+---+---+---+-----+
| [Page 1 of              |                     |       |   |   |   |     |
| 4]{.underline}          |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| **[Company              |                     | **[   |   |   |   |     |
| Name:]{.underline}**    |                     | Date: |   |   |   |     |
|                         |                     | ]{.un |   |   |   |     |
|                         |                     | derli |   |   |   |     |
|                         |                     | ne}** |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| **[Vehicle              |                     |       |   |   |   |     |
| Identi                  |                     |       |   |   |   |     |
| fication]{.underline}** |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| VIN #:                  |                     | DOT   |   |   |   |     |
|                         |                     | #:    |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| License #:              | State:              | Unit  |   |   |   |     |
|                         |                     | ID #: |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Make:                   | Model:              | Year: |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| **[Staffing             |                     |       |   |   |   |     |
| Inf                     |                     |       |   |   |   |     |
| ormation]{.underline}** |                     |       |   |   |   |     |
|                         |                     |       |   |   |   |     |
| At a minimum any Crash  |                     |       |   |   |   |     |
| Rescue apparatus        |                     |       |   |   |   |     |
| assigned to a helibase  |                     |       |   |   |   |     |
| for Crash Rescue        |                     |       |   |   |   |     |
| responsibilities must   |                     |       |   |   |   |     |
| have; three trained and |                     |       |   |   |   |     |
| qualified structural or |                     |       |   |   |   |     |
| Crash Rescue            |                     |       |   |   |   |     |
| Firefighters            |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
|                         |                     | *     |   |   |   |     |
|                         |                     | *Sati |   |   |   |     |
|                         |                     | sfact |   |   |   |     |
|                         |                     | ory** |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
|                         |                     | **    |   | * |   |     |
|                         |                     | Yes** |   | * |   |     |
|                         |                     |       |   | N |   |     |
|                         |                     |       |   | o |   |     |
|                         |                     |       |   | * |   |     |
|                         |                     |       |   | * |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Photo Identification    |                     |       |   |   |   |     |
| Card for each           |                     |       |   |   |   |     |
| crewmember              |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Firefighter trained and |                     |       |   |   |   |     |
| qualified in accordance |                     |       |   |   |   |     |
| with NFPA 1001          |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Driver Operator trained |                     |       |   |   |   |     |
| and qualified in        |                     |       |   |   |   |     |
| accordance with NFPA    |                     |       |   |   |   |     |
| 1002 and meet current   |                     |       |   |   |   |     |
| licensing requirements  |                     |       |   |   |   |     |
| for the state that the  |                     |       |   |   |   |     |
| apparatus is licensed   |                     |       |   |   |   |     |
| in                      |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Fire Officer 1 trained  |                     |       |   |   |   |     |
| and qualified in        |                     |       |   |   |   |     |
| accordance with NFPA    |                     |       |   |   |   |     |
| 1021                    |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| **Contractor shall      |                     |       |   |   |   |     |
| provide a manifest of   |                     |       |   |   |   |     |
| all employees, proof of |                     |       |   |   |   |     |
| qualifications for each |                     |       |   |   |   |     |
| crew member upon        |                     |       |   |   |   |     |
| arrival to the incident |                     |       |   |   |   |     |
| helibase**              |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| **[Vehicle              |                     | #     |   |   |   |     |
| L                       |                     | ## Sa |   |   |   |     |
| icensing]{.underline}** |                     | tisfa |   |   |   |     |
|                         |                     | ctory |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
|                         |                     | **    |   | * |   |     |
|                         |                     | Yes** |   | * |   |     |
|                         |                     |       |   | N |   |     |
|                         |                     |       |   | o |   |     |
|                         |                     |       |   | * |   |     |
|                         |                     |       |   | * |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Vehicle meets licensing |                     |       |   |   |   |     |
| requirements            |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Operator meets          |                     |       |   |   |   |     |
| licensing requirements  |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Vehicle meets insurance |                     |       |   |   |   |     |
| requirements            |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Vehicle meets CVSA      |                     |       |   |   |   |     |
| requirements            |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| **[PERSONAL PROTECTIVE  |                     | *     |   |   |   |     |
| EQUIPMENT IN ACCORDANCE |                     | *Sati |   |   |   |     |
| WITH NFPA               |                     | sfact |   |   |   |     |
| 1971]{.underline}**     |                     | ory** |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
|                         |                     | **    | * |   | * |     |
|                         |                     | Yes** | * |   | * |     |
|                         |                     |       | N |   | Q |     |
|                         |                     |       | o |   | t |     |
|                         |                     |       | * |   | y |     |
|                         |                     |       | * |   | * |     |
|                         |                     |       |   |   | * |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Structural Firefighting |                     |       |   |   |   |     |
| boots, one (1) pair per |                     |       |   |   |   |     |
| person                  |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Structural Firefighting |                     |       |   |   |   |     |
| Helmet with shield or   |                     |       |   |   |   |     |
| goggles, one (1) per    |                     |       |   |   |   |     |
| person                  |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Structural Firefighting |                     |       |   |   |   |     |
| gloves, one (1) pair    |                     |       |   |   |   |     |
| per person              |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| PBI or Nomex structural |                     |       |   |   |   |     |
| hood, one (1) per       |                     |       |   |   |   |     |
| person                  |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Structural turnout coat |                     |       |   |   |   |     |
| and pants, one (1) set  |                     |       |   |   |   |     |
| per person              |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Personnel are required  |                     |       |   |   |   |     |
| to wear cotton or Nomex |                     |       |   |   |   |     |
| under garments against  |                     |       |   |   |   |     |
| skin under clothing     |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Fire Shelter, one (1)   |                     |       |   |   |   |     |
| per person              |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| **[CRASH RESCUE         |                     |       | * |   |   |     |
| PERSONNEL MINIMUM       |                     |       | * |   |   |     |
| TRAINING AND            |                     |       | S |   |   |     |
| QUALIF                  |                     |       | a |   |   |     |
| ICATIONS]{.underline}** |                     |       | t |   |   |     |
|                         |                     |       | i |   |   |     |
|                         |                     |       | s |   |   |     |
|                         |                     |       | f |   |   |     |
|                         |                     |       | a |   |   |     |
|                         |                     |       | c |   |   |     |
|                         |                     |       | t |   |   |     |
|                         |                     |       | o |   |   |     |
|                         |                     |       | r |   |   |     |
|                         |                     |       | y |   |   |     |
|                         |                     |       | * |   |   |     |
|                         |                     |       | * |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
|                         |                     |       | * |   |   | **N |
|                         |                     |       | * |   |   | o** |
|                         |                     |       | Y |   |   |     |
|                         |                     |       | e |   |   |     |
|                         |                     |       | s |   |   |     |
|                         |                     |       | * |   |   |     |
|                         |                     |       | * |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Hazardous Material      |                     |       |   |   |   |     |
| Awareness and           |                     |       |   |   |   |     |
| Operations-First        |                     |       |   |   |   |     |
| Responder and           |                     |       |   |   |   |     |
| requrrency in           |                     |       |   |   |   |     |
| compliance              |                     |       |   |   |   |     |
| (CFR1910.120)           |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| S-130 and S-190 and     |                     |       |   |   |   |     |
| annual shelter          |                     |       |   |   |   |     |
| deployment training     |                     |       |   |   |   |     |
| (NWCG 310-1)            |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| I-100, I-200 Incident   |                     |       |   |   |   |     |
| Command System (NWCG    |                     |       |   |   |   |     |
| 310-1)                  |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Assure that all         |                     |       |   |   |   |     |
| personal meet           |                     |       |   |   |   |     |
| recurrence training in  |                     |       |   |   |   |     |
| accordance with NFPA    |                     |       |   |   |   |     |
| 405, chapter 12 and     |                     |       |   |   |   |     |
| provide documentation   |                     |       |   |   |   |     |
| of live fire training   |                     |       |   |   |   |     |
| within the last two     |                     |       |   |   |   |     |
| years                   |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| One (1) member of the   |                     |       |   |   |   |     |
| Crash Rescue crew must  |                     |       |   |   |   |     |
| be currently certified  |                     |       |   |   |   |     |
| as a EMT/B              |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Blood borne pathogens   |                     |       |   |   |   |     |
| training in accordance  |                     |       |   |   |   |     |
| with OSHA 1910.1030     |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Composite material      |                     |       |   |   |   |     |
| safety training for A/C |                     |       |   |   |   |     |
| firefighting in         |                     |       |   |   |   |     |
| accordance with 14 CFR  |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Provide proof of annual |                     |       |   |   |   |     |
| SCBA qualitative fit    |                     |       |   |   |   |     |
| testing and training in |                     |       |   |   |   |     |
| accordance with OSHA    |                     |       |   |   |   |     |
| 1910                    |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| # HEL                   |                     |       |   |   |   |     |
| IBASE CRASH RESCUE INSP |                     |       |   |   |   |     |
| ECTION FORM Page 2 of 4 |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| # [APPARATUS SPEC       |                     |       | * |   |   |     |
| IFICATIONS]{.underline} |                     |       | * |   |   |     |
|                         |                     |       | S |   |   |     |
|                         |                     |       | a |   |   |     |
|                         |                     |       | t |   |   |     |
|                         |                     |       | i |   |   |     |
|                         |                     |       | s |   |   |     |
|                         |                     |       | f |   |   |     |
|                         |                     |       | a |   |   |     |
|                         |                     |       | c |   |   |     |
|                         |                     |       | t |   |   |     |
|                         |                     |       | o |   |   |     |
|                         |                     |       | r |   |   |     |
|                         |                     |       | y |   |   |     |
|                         |                     |       | * |   |   |     |
|                         |                     |       | * |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
|                         |                     |       | * |   |   | **N |
|                         |                     |       | * |   |   | o** |
|                         |                     |       | Y |   |   |     |
|                         |                     |       | e |   |   |     |
|                         |                     |       | s |   |   |     |
|                         |                     |       | * |   |   |     |
|                         |                     |       | * |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| 500 gallon water tank   |                     |       |   |   |   |     |
| in accordance with NFPA |                     |       |   |   |   |     |
| 1901                    |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Comply with current     |                     |       |   |   |   |     |
| U.S. D.O.T. regulations |                     |       |   |   |   |     |
| and NFPA 1901           |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Off --paved road        |                     |       |   |   |   |     |
| capability (maximum     |                     |       |   |   |   |     |
| 170' wheel base)        |                     |       |   |   |   |     |
| capable of operating on |                     |       |   |   |   |     |
| mountainous terrain and |                     |       |   |   |   |     |
| grades up to 9%         |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| 500 GPM rated pump in   |                     |       |   |   |   |     |
| accordance with NFPA    |                     |       |   |   |   |     |
| 1901                    |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Documentation of annual |                     |       |   |   |   |     |
| pump service test in    |                     |       |   |   |   |     |
| accordance with NFPA    |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| High visibility paint   |                     |       |   |   |   |     |
| and contrasting         |                     |       |   |   |   |     |
| markings                |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Code 3 lighting/warning |                     |       |   |   |   |     |
| devices including siren |                     |       |   |   |   |     |
| with minimum 120DB      |                     |       |   |   |   |     |
| rating and PA system    |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Two (2) cab mounted     |                     |       |   |   |   |     |
| spot lights for night   |                     |       |   |   |   |     |
| operations              |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| All thread connections  |                     |       |   |   |   |     |
| to be National Hose     |                     |       |   |   |   |     |
| (NH) threads            |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| One 2 ½ inch valve      |                     |       |   |   |   |     |
| intake with (NH)        |                     |       |   |   |   |     |
| threads                 |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| 500'double jacket 1.5   |                     |       |   |   |   |     |
| or 1.75 synthetic hose, |                     |       |   |   |   |     |
| coupled with 1.5 NH in  |                     |       |   |   |   |     |
| 50' length. 300'        |                     |       |   |   |   |     |
| configured as           |                     |       |   |   |   |     |
| pre-connect attack hose |                     |       |   |   |   |     |
| line in hose trays,     |                     |       |   |   |   |     |
| available for rapid     |                     |       |   |   |   |     |
| initial attack          |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| 300' double jacket 2.5" |                     |       |   |   |   |     |
| or greater supply hose  |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Two (2) lengths hard    |                     |       |   |   |   |     |
| suction hose rated for  |                     |       |   |   |   |     |
| us with pump capacity   |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Hard suction strainer   |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Two (2) universal       |                     |       |   |   |   |     |
| spanner wrenches        |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| One (1) adjustable      |                     |       |   |   |   |     |
| hydrant wrench          |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Assorted adapters,      |                     |       |   |   |   |     |
| reducers, increasers,   |                     |       |   |   |   |     |
| double males, double    |                     |       |   |   |   |     |
| females connectors to   |                     |       |   |   |   |     |
| facilitate refilling    |                     |       |   |   |   |     |
| and inter-engine        |                     |       |   |   |   |     |
| operations              |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| One (1) 6ft. pike pole  |                     |       |   |   |   |     |
| or trash hook           |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| One (1) Halligan tool   |                     |       |   |   |   |     |
| or other prying tool    |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Two (2) wheel chocks    |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+
| Minimum AFFF foam       |                     |       |   |   |   |     |
| supply 6%: 50 gallons,  |                     |       |   |   |   |     |
| or 3%: 25 gallons,      |                     |       |   |   |   |     |
| or1%: 10 gallons        |                     |       |   |   |   |     |
+-------------------------+---------------------+-------+---+---+---+-----+

  ------------------------------------------------- ---------- ----------
  **[Vehicle Condition]{.underline}**                          

  Glass (chips/cracks)                                         

  Body Condition (dents/scratches)                             

  Seat Belt for all passengers                      **Yes**    **No**
  ------------------------------------------------- ---------- ----------

+------------------------------------------------+------+------+------+
| #  HE                                          |      |      |      |
| LIBASE CRASH RESUE INSPECTION FORM Page 3 of 4 |      |      |      |
+------------------------------------------------+------+------+------+
| **[APPERATUS EQUIPMENT MINIMUM                 | ###  |      |      |
| REQUIRMENTS]{.underline}**                     | Sati |      |      |
|                                                | sfac |      |      |
|                                                | tory |      |      |
+------------------------------------------------+------+------+------+
|                                                | **Y  | **   | **Q  |
|                                                | es** | No** | ty** |
+------------------------------------------------+------+------+------+
| Three (3) complete SCBA's with one extra       |      |      |      |
| cylinder per pack                              |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) programmable VHF portable radio        |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) narrow band programmable mobile radio  |      |      |      |
| and two (2) narrow band programmable portable  |      |      |      |
| radios                                         |      |      |      |
+------------------------------------------------+------+------+------+
| Two (2) 20 lb. Dry Chemical portable fire      |      |      |      |
| extinguishers, foam compatible                 |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) portable aircraft extrication kit      |      |      |      |
| portable including as a minimum                |      |      |      |
|                                                |      |      |      |
| 1.  Hack saw                                   |      |      |      |
|                                                |      |      |      |
| 2.  Seatbelt cutter                            |      |      |      |
|                                                |      |      |      |
| 3.  Serrated fire axe/ metal cutting hatchet   |      |      |      |
|                                                |      |      |      |
| 4.  Pry bar                                    |      |      |      |
|                                                |      |      |      |
| 5.  Pry axe                                    |      |      |      |
|                                                |      |      |      |
| 6.  Bolt cutter                                |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) portable sawzall with power and a      |      |      |      |
| minimum of five (5) blades                     |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) ladder, combi or roof ladder a minimum |      |      |      |
| of 14 feet                                     |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) flat head axe or sledge hammer         |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) suction/ rubber mallet                 |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) round point shovel                     |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) bolt cutter                            |      |      |      |
+------------------------------------------------+------+------+------+
| Cribs- Step Chocks                             |      |      |      |
+------------------------------------------------+------+------+------+
| Aqueous Film forming (AFFF) Class B foam       |      |      |      |
| concentrate (1% or 3% or 6%) sufficient to     |      |      |      |
| generate foam solution for 750 gallons of      |      |      |      |
| water                                          |      |      |      |
+------------------------------------------------+------+------+------+
| Two (2) portable battery powered hand lights   |      |      |      |
+------------------------------------------------+------+------+------+
| Medical Equipment                              |      |      |      |
|                                                |      |      |      |
| 1.  Two (2) long backboards with straps        |      |      |      |
|                                                |      |      |      |
| 2.  Various size c-collars                     |      |      |      |
|                                                |      |      |      |
| 3.  Oxygen D cylinder and regulator with       |      |      |      |
|     two (2) re-breather masks                  |      |      |      |
|                                                |      |      |      |
| 4.  One (1) bag valve mask with assorted       |      |      |      |
|     airways                                    |      |      |      |
|                                                |      |      |      |
| 5.  Two (2) burn kits                          |      |      |      |
|                                                |      |      |      |
| 6.  First aid kit                              |      |      |      |
+------------------------------------------------+------+------+------+
| Hazardous material spill kit -- One (1) five   |      |      |      |
| gallon bucket of absorbent, twenty (20) pig    |      |      |      |
| pads and one (1) boom                          |      |      |      |
+------------------------------------------------+------+------+------+
| Pry bar --minimum 5 foot length                |      |      |      |
+------------------------------------------------+------+------+------+
| Two (2) constant flow rated nozzles with       |      |      |      |
| manual gallonage adjustment and full-flow      |      |      |      |
| waterway ball shutoff valves                   |      |      |      |
+------------------------------------------------+------+------+------+
| One (1) minimum 1 foot piercing applicator     |      |      |      |
| (nozzle) rated GPM shall match the rated GPM   |      |      |      |
| of the educator                                |      |      |      |
+------------------------------------------------+------+------+------+

+--------------------------------------------------------+------+------+
| ### HELIBASE CRASH RESCUE INSPECTION FORM PAGE 4 OF 4  |      |      |
+--------------------------------------------------------+------+------+
| # [FOAM GENERATING REQUIRMENTS]{.underline}            | **Sa |      |
|                                                        | tisf |      |
|                                                        | acto |      |
|                                                        | ry** |      |
+--------------------------------------------------------+------+------+
|                                                        | **Y  | **   |
|                                                        | es** | No** |
+--------------------------------------------------------+------+------+
| Pump at 190 GPM foam solution for 2.5 minutes          |      |      |
| utilizing two 1.5" or 1.75" attack hose lines          |      |      |
+--------------------------------------------------------+------+------+
| Pump at 95 GPM foam solution for 5 minutes utilizing   |      |      |
| one 1.5" or 1.75" attack hose line                     |      |      |
+--------------------------------------------------------+------+------+
| Performance is predicted upon deployment of double     |      |      |
| jacket all polyester hose rated and UL approved for    |      |      |
| 300 PSI service test and 600 PSI burst test            |      |      |
+--------------------------------------------------------+------+------+
| Performance is predicted upon deployment of            |      |      |
| combination, constant flow rated nozzles with manual   |      |      |
| gallonage adjustment and full-flow waterway ball       |      |      |
| shutoff valves                                         |      |      |
+--------------------------------------------------------+------+------+
| Performance is predicted upon deployment of in-line or |      |      |
| by pass discharge side educators or an around-the-pump |      |      |
| proportioner designed for flow rates cited and         |      |      |
| equipped with adjustable metering devices with ball    |      |      |
| checks located at the venturis                         |      |      |
+--------------------------------------------------------+------+------+
| Only AFFF synthetic foam concentrate is permitted      |      |      |
+--------------------------------------------------------+------+------+
| When utilizing inline or by pass educators, attack     |      |      |
| hose lines may not exceed 150 feet in overall length   |      |      |
+--------------------------------------------------------+------+------+
| The use of aspirating nozzles will not be permitted    |      |      |
| for initial attack operations                          |      |      |
+--------------------------------------------------------+------+------+
| # [ADDITIONAL REQUIRMENTS]{.underline}                 | **Sa |      |
|                                                        | tisf |      |
|                                                        | acto |      |
|                                                        | ry** |      |
+--------------------------------------------------------+------+------+
|                                                        | **Y  | **   |
|                                                        | es** | No** |
+--------------------------------------------------------+------+------+
| Contractor may be required to perform a training       |      |      |
| evolution using suppression agents at their own        |      |      |
| expense once assigned to a helibase. Training          |      |      |
| evolution will demonstrate readiness to don PPE with   |      |      |
| SCBA, engage apparatus, and ability to produce         |      |      |
| adequate foam                                          |      |      |
+--------------------------------------------------------+------+------+
| Contractor or Cooperator must have signed copy of the  |      |      |
| EERA or Coop Agreement, Employee qualification         |      |      |
| worksheet, apparatus inventory list, and a copy of the |      |      |
| apparatus specification on the apparatus at all times  |      |      |
| during this contract and provide a copy to the         |      |      |
| Helibase Manager upon arrival at the helibase          |      |      |
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| COMMENTS;                                              |      |      |
+--------------------------------------------------------+------+------+
| **[Signature of Contractor]{.underline}                |      |      |
| [Date]{.underline}**                                   |      |      |
+--------------------------------------------------------+------+------+
| **[Signature of Inspector]{.underline}                 |      |      |
| [Date]{.underline}**                                   |      |      |
+--------------------------------------------------------+------+------+
| **[Inspectors' Agency]{.underline} [Inspector's Phone  |      |      |
| \#]{.underline}**                                      |      |      |
+--------------------------------------------------------+------+------+