Polk County Sheriff S Office s2

POLK COUNTY SHERIFF’S OFFICE ROLL-BACK OR SLIDE-BACK CARRIER WRECKER INSPECTION FORM

Date of Inspection: Sector/Beat:

Wrecker Company: Address:

Phone # Day: Night: Mobile: Wrecker Owner:

Vehicle: Year/Make: Tag #: Unit #: Vin #:

Wrecker: Make/Model: Winch(es): Make/Serial #:

INSURANCE REQUIREMENTS

Insurance Company: Agency: Expiration Date:

Wrecker Insurance Statement of Compliance on file Current Certificate of Insurance on file

REQUIRED EQUIPMENT TO BE INSPECTED – (EACH WRECKER)

Wrecker manufacturer’s rated capacities Bolt cutters (min. ½” opening) (1 pair)

Truck chassis – 10,000 pounds GVW Jumper cables (1 set) with a minimum 16 ft. bed

Winch – manufacturer’s rating of at least 4-plus ton capacity Flashlight (1 ea.)

Dual rear wheels 30-minute fuses/electronic equivalent (5 ea.)

50 ft. 3/8 inch cable Safety cones or triangle reflectors ( 3 ea.)

Minimum of two safety tie down chains (10 ft. ea.) Fire extinguisher – CO2 or dry chemical, or equivalent (5 lb. min.) Snatch block 4-way lug wrench (1 ea.)

Extra towing chain 6 to 8 ft. with hooks Red reflectors (1 set)

Communication radio or mobile/cellular telephone (1 ea.) Heavy-duty push broom (min. 24” width) (1 ea.)

Rotor beam or strobe-type light (amber in color) 50 lbs. of sand or equivalent

Clearance and marker lights Proper lettering-professionally painted (both sides)

Two (2) spot (flood) lights mounted on rear Square shovel (1 ea.)

Ax (1 ea.) Cradle, tow plate, or tow sling with safety chains

Crowbar or pry bar (min. length 30”) (1 ea.) All other equipment required by law

Inspected by: Company Representative: Additional Comments:

PCSO FORM 1650 (01/15/13)