Grant Number: NN-C04/12-17 Organization Information EMS Agency: Yes Organization Name: COLONIAL BEACH SQUAD Address First Line: 225 DENNISON STREET Address Second Line: City: COLONIAL BEACH State: VA Zip: 22443 City/County: WESTMORELAND Phone Number: (804)224-7750 Regional Council: Peninsulas EMS Council FIN#: 54-1025311 Organization Structure: EMS - Volunteer Organization Type: Non-Governmental

Personnel Information

Number of Certified Personnel First Responder: 0 EMT: 10 : 3 Advance EMT: 2 Enhanced: 0 Intermediate 2 Coordinator: 0 Education Coordinator: 0

Certification First Responder: 0 EMT: 10 Paramedic: 3 Advance EMT: 3 Enhanced: 0 Intermediate 1 Advanced Life Support Coordinator: 0 Education Coordinator: 0 Driver: 0 Other: 7 Total: 24 Personnel Career: 0 Volunteer: 24 Total: 24 Comments:

Call Activity and Demographic Information

BLS Calls: 200 ALS Calls: 57 Calls Unable To Respond: 9

Calls Outside Primary Service Area: 7 Avg Call Time(minutes): 125 Average Round Trip Mileage: 77 Avg Mileage To Nearest Hospital: 35

Square Miles of Service Area: 75 Population of Service Area: 15,500 Total Number of Stations: 1 Comments: The Colonial Beach Volunteer Rescue Squad currently has a 75 square miles of service areas and has only one station currently. We currently have approximately 15,500 people who reside in our area of coverage and the population grows by 75% during the summer months as people travel and stay here for vacations. Agency Vehicle Information

This Organization has additional not listed:No Are any vehicles used by other jurisdictions? Yes Vehicle Jurisdiction comments: 1-8 is currently being utilized by the Westmoreland County Department of Emergency Services. All maintenance and expenditures are paid for by the Colonial Beach Volunteer Rescue Squad. This is due to a Memo of Agreement that our former Chief set in place with the Westmoreland Department Of Emergency Services.

Page 1 Grant Number: NN-C04/12-17 Agency Vehicle Information

. Chassis Engine Unit# VIN Box Year Make Model Vehicle Type Class Permit 4WD Mileage Hours 1-8 1GB3K0C85DF164165 2013/2013CHEVROL CK31401 TYPE I Ground Y 118726 ET AMBULANCE Ambulance 1-7 1GB5G5CL0D1110477 2013/2013CHEVROL 4500 TYPE III Ground N 53842 ET AMBULANCE Ambulance 1-9 1GB6GUCLXG1249739 2016/2016CHEVROL 4500 TYPE III Ground N 9853 ET AMBULANCE Ambulance 1 1FT7W2B64GEB96810 2016/2016Ford F-250 QUICK Non-Transport Y 3629 RESPONSE Vehicle

Page 2 Grant Number: NN-C04/12-17 Financial Information

Assets Liabilities

Cash Balance: $219,118.00 Balance of Open Accounts: $0.00 Real Estate: $0.00 Notes or Mortgages Owed: $0.00 $343,800.00 Investments (unrestricted): Indebtedness / Obligations: $0.00 $79,000.00 Equipments, Vehicles, etc: $225,892.00 Restricted Funds:

Restricted Funds Description: Description of Indebtedness / Obligations: Building fund and Ambulance fund which will be used for The Colonial Beach Volunteer Rescue Squad currently has our proportion of the grant. no debt. Other Fees

Amount received from EMS Fee for Service for Last Fiscal Year: $120,000.00

Service Fee Charged:Yes Service Fee per Call: $450.00 Cost Recovery: 35.00%

Receipts/Revenue Expenditures

Local Government: $55,000.00 Operational Expenses: $125,000.00 26% Return to Locality: $4,700.00 Personnel Costs: $0.00 Donations: $9,004.00 Capital Expenditures: $45,000.00 EMS Fee for Service: $120,000.00 Other Expenses: $0.00 Fund Raising: $22,003.00 Non Operational: $0.00

Interest Dividends: $500.00 Definition of Capital Expenditures: Grants: $82,790.00 Renovations needed to be done to station. Had to tear down and existing part of the building. Other Revenue: $0.00

Description of Receipts/ Revenue: Grant received 2016 for 50/50 on purchase of new ambulance. Finance Summary

Total Assets: $867,810.00 Net Worth: $867,810.00 Total Liabilities: $0.00 Beginning Balance: $219,118.00 Total Receipts: $293,997.00 Cash Difference: $123,997.00 Total Expenditures: $170,000.00 Ending Balance: $343,115.00

Page 3 Grant Number: NN-C04/12-17

Requested Items Information

Item Name: Stryker Power Load Item Type: Rescue Equipment - Misc. Req. Quantity: 1 Funding Level: 80 / 20 Action Add Current Quantity:1 Total Price: $44,194.92 Matching Funds:: $8,838.98 State Funds: $35,355.94 Comments: The Colonial Beach Volunteer Rescue Squad will match the grant fund from our Ambulance and Building funds. Hardship Justification:The Colonial beach Volunteer Rescue Squad is a small organization. Due to our limited jobs in our Town it is getting harder to recruit new members. Most people have to travel at least 60 minutes to find good jobs. We also have a budget that could be cut short at anytime if we have to replace an Ambulance in the near future. We also have members that currently have minor back issues and some that can not lift heavy patients. Having the grant approved for this power load stretcher would greatly reduce heavy lifting and chances of injuring a members back. We currently have a Power Load Stretcher on our new Ambulance 1-9. This stretcher system has been extraordinary during the loading and unloading of a patient. For example we have a member that weighs approximately 120lbs and with a push of one button that member has successfully loaded and unloaded a patient utilizing one button. This stretcher system has already proven it's worth by reducing workers unnecessary back problems due to loading and unloading patients.

Supporting Documents Name Type Description Size F-230015194/stryker quote.pdf Quote Stryker Power Load Quote 940 KB

Page 4 Grant Number: NN-C04/12-17 Affirmation

Brief Project Description: The Colonial Beach Volunteer Rescue Squad is requesting 80/20 funding to purchase a Stryker Power Load Stretcher. Currently the Colonial Beach Volunteer Rescue Squad has a Stryker Power Load Stretcher in our new Ambulance 1- 9. This piece of equipment has been extraordinary for our members loading and unloading bariatric patients and has saved many members who currently have minor back issues with easy loading and unloading of a patient. The Colonial Beach Volunteer Rescue Squad would like to place this new stretcher on Ambulance 1-7 to help out the other members who are always not privy to being able to utilize the Stryker Power Stretcher. Since Ambulance 1-9 already has a Stryker Power Load Stretcher then if Ambulance 1-7 was equipped with one then in an emergency breakdown of one of the to Ambulances or if Ambulance 1-7 was staffed with a higher level provider then the would be compatible with one another and you could simply switch out one stretcher to the next without any unnecessary moving of patients and adding more time to the transport from one stretcher to the next that would cause delay to the patients well-being and fast response to the hospital. Having the Power Load Stretcher System would greatly reduce unnecessary back injuries while loading and unloading a patient for transport. Project /Equipment Sustainability: The Colonial Beach Volunteer Rescue Squad if funded would immediately purchase the Stryker Power Load Stretcher and have in installed without delay. The next step would be to train all members who have not been trained on the new stretcher and then have the stretcher ready for service. Supporting Documents Name Type Description Size F155104735/stryker quote.pdf Quote Stryker Power Load Stretcher Quote 940.35 KB F397304889/cbvrs2016taxreturn.pdf IRS Letter / 990 / W9 2016 CBVRS Tax Return 965.02 KB F-308563324/cbvrsfinacialstate.pdf Other CBVRS Financial Statement 854.74 KB F-1363630737/countyadminletterfin.pdf Other County Admin verifying FIN 440.94 KB F-274684956/irsfinissueletter.pdf Other IRS Issuance of FIN Letter 544.42 KB

Authorized Agent First Name: JOSEPH Last Name: STRAUGHAN Phone#: (804)224-7750 Email: [email protected] Signature: Joseph C Straughan Jr Finacial Officer First Name: JOSEPH Last Name: STRAUGHAN Phone#: (804)224-7750 Email: [email protected] Signature: Joseph C. Straughan Jr Operational First Name: DOUGLAS Last Name: JOHNSON Phone#: (540)741-1167 Email: [email protected] Signature: Douglas R Johnson, MD

Page 5