Upper Leacock Fire Company

SOG's


 

 

Section 14    Driver Trainee & Qualified Driver Rules & Regulations
 

1.    The Upper Leacock Fire Company Driver Training Manual is a separate manual that was designed specifically for the Driver Trainee Candidate. The Fire Company Engineer is required to issue all new Driver Trainee Candidates a copy of this manual.

2.    The Driver Training Manual contains the following: Driver Training Application, Driver Trainee and Qualified Driver Rules and regulations, Pennsylvania vehicle code laws concerning emergency vehicle, Accident report guidelines, Driver training qualification standard, Driving safety practices for the Driver Trainee Candidate, Upper Leacock Twp. Road listing guide, Driver training log and acknowledgement form, and misc. information. Although this manual was designed for the new Driver Trainee Candidates, it also has some important information that pertains to all Fire Company Members including Qualified Drivers.

3.    This section of the Upper Leacock Fire Company Standard Operating Guideline Manual contains the important information taken from the Driver Training Manual that pertains to all Fire Company Members and qualified drivers. The sections taken from the manual include: Driver Trainee and Qualified Driver rules and regulations, Accident report guidelines, and Driver training qualification standards.

4.    Any Fire Company Member who wishes to review the complete Driver Training Manual may review a copy stored in the Fire Company Office or above the sign in desk in engine bays.

 

DRIVING TRAINEE AND QUALIFIED DRIVER RULES AND REGULATIONS

 

1.    Any member of the Upper Leacock Fire Company who wants to be put on driver training must fill out an application and have the approval of the Fire Company Engineer and Chief Officer.

2.    All Driver Trainee Candidates and Qualified Drivers must possess a valid Pennsylvania drivers License.

3.    All Driver Trainee Candidates and Qualified Drivers must be 21 years on age to drive Engine 3-11-1, Engine 3-11-2, and Air 3-11. You must be 18 years of age to drive Squad 3-11-1 and Squad 3-11-2 (fine police unit).

4.    All Driver Trainee Candidates should be under the direct supervision of the Fire Company Engineer or his designee, while operating any piece of apparatus during driver training.

5.    All Driver Trainee Candidates and Qualified Drivers should notify the Fire company Engineer and Chief Officer in the event that their driver's license was suspended, revoked, or expired.

6.    Any Driver Trainee Candidate that receives a traffic citation or is involved in any motor vehicle accident is required to notify the Fire Company Engineer and Chief Officer A.S.A.P. (notification is also required to be made even if a citation or accident occurs outside of a Fire Company function).

7.    The Fire Company Engineer and Chief Officer have the right ot suspend driving privileges of any Qualified Driver o Driver Trainee Candidate at anytime due to unsafe driving violations of Fire Company policy.

8.    All Driver Trainee Candidates are expected to keep and active log of all driver training that is completed and muse t complete and emergency vehicles safety checklist before driving any apparatus at anytime during driver training.

9.    All Driver Trainee Candidates that successfully meet the qualification standards set fourth in this driver training manual will be recommended by the Fire Company Engineer for that candidate to be listed as a Qualified Driver by the Fire Chief.

10.    The Fire Chief is the only person allowed by the Pennsylvania Law to authorize a member to drive any Fire Company apparatus. The Fire Chief will issue a "Certification of Authorization" card upon successful completion of the driver training qualification standards and the Fire Company Engineer's recommendation.

11.    The Fire Chief and Engineer have the right to make any changes or additions to this driver-training manual or to the driver-training program. Changes or additions to this driver-training manual or to the driver-training program. Changes or additions by the Fire Company Engineer must be approved by the Fire Chief.

12.    All Driver Trainee Candidates must complete their driving training. Failure to complete their qualification standards will require a driver training. Failure to complete their qualification standards will require a candidate to fill out a new driver trainee application and start the driving training program all over again from the beginning UNLESS the Engineer grants an extension based on the circumstances beyond the Driver Trainee Candidate's control.

13.    Under no circumstances is a Driver Trainee Candidate permitted to drive any piece of apparatus to an emergency call UNLESS a Chief Officer gives the Candidate permission at the time of the emergency, due to special circumstances. In the event that permission to drive is given to the candidate Extreme Caution should be used during the response. If the candidate does not feel comfortable driving the apparatus or operating the pump during an emergency, he should not drive.

14.    Driver Trainee Candidates and Qualified Drivers are not permitted to smoke while driving any piece of apparatus.

15.    No one is permitted to drive any Fire Company apparatus while under the influence of an alcoholic beverage or controlled substance, which renders the person incapable of safe driving.

16.    Any Driver Trainee Candidate or Qualified Driver is required to notify the Fire Company Engineer and Chief Officer A.S.A.P. in the event that they can no longer drive or operate equipment on a piece of apparatus due to illness, medical problems, physical problems, or any other condition that exists.

17.    All Driver Trainee Candidates are required to complete 15 hours of driver training before they are eligible to take their qualification test on all apparatus except Squad 3-11-1 and Squad 3-11-2. In addition to the 15 hours of driver training required, each Driver Trainee Candidate must drive a minimum of 50 miles before they are eligible to take their qualification test.

18.    The Fire Company Engineer and Chief Officer have the right to reduce the driver training hours for 15 to 8 hours and the 50 miles required to 20 miles for any Driver Trainee Candidate who possess a CDL. License, or has completed a state approved 16 hour Pump Operation class. A reduction in hours and road miles may be possible for any Driver Trainee Candidate who was Qualified Driver for another fire company prior to his or her membership with our Fire Company. The Fire Company Engineer and Chief Officer have the right to make reductions or require additional hours and road miles based on each individual Driver Trainee Candidates need or qualifications.

19.    It is the responsibility of the Fire Company Engineer to ensure that each Driver Trainee Candidate has been given an up to date copy of the driver training manual and any other information beneficial to the Driver Trainee Candidate.

20.    It is the responsibility of the Fire Company Engineer to retain all records of each Driver Trainee Candidate.

21.    All Qualified Drivers are required to adhere to the following Fire Company apparatus response protocols for the following emergency calls:   

  1. Structure, Building, Dwelling, and Barn Fires:
  2. Automatic Alarms:
  3. Engine Company Transfers:
  4. All Other Calls

    - A Chief Officer or Officer in Charge has the right to request a specific piece of apparatus which does not follow this protocol under certain circumstances, which he or she deems necessary.

22A.    All Qualified Drivers should use the emergency lighting and audible siren on all emergency calls EXCEPT for the following:

  1. Emergency work details
  2. Pump Details
  3. Automatic Alarms reported false
  4. Engine Company Transfers
  5. Public Service Calls
  6. Controlled Burns

- This also includes any call when you are instructed to respond at a reduced rate or under caution. No emergency lighting or sirens will be used for above-mentioned responses. When responding emergency rate to an emergency call, ALL emergency lights and audible sirens will be activated.

22B.    The Officer in Charge in the Officers seat up front should control all siren functions, air horn functions, and radio communications, NOT the Driver.

23.    All Driver Trainee Candidates and Qualified Drivers are required to wear their seatbelts at all times. They are also responsible to see that all crewmembers have their seatbelts on also.

24.    If a complaint is received from a Fire Company Member or private citizen in regards to Any Unsafe Driving Act committed by ANY of our members the following complaint protocol will be followed;

  1. All complaints must be written on an approved Upper Leacock Fire Company Complaint Form within 30 days from the date that the accused act had occurred.
  2. All complaints will be turned into a Chief Officer and Fire Company Engineer who will investigate each complaint.
  3. All investigations must be completed within 30 days upon receipt of the complaints unless certain circumstances arise. Upon completion of investigation, a write response will be given to the complainant and the accused member.
  4. The investigating Chief Officer and Fire Company Engineer have the right to incorporate any outside agency to assist in the investigation of the driving complaint such as Police, etc.

25.    All Driver Trainee Candidates and Qualified Drivers are responsible to see that ALL equipment is returned and placed back in service prior to leaving the scene of an emergency cal or training event.

26.    All Driver Trainee Candidates and Qualified Drivers are responsible to fuel up the apparatus they were driving if the fuel gauge is below 3/4 a tank.

27.    All Driver Trainee Candidates and Qualified Drivers are responsible to see that all apparatus is cleaned up upon returning from a training event or emergency call. (This mainly pertains to washing off salt residue during winter months).

28.    All Driver Trainee Candidates and Qualified Drivers are are required to fill out the apparatus logs upon returning from any emergency call or training event.

29.    All Qualified Drivers should yield the right of way to drive any apparatus during an emergency call if a Fie Company Engineer or Assistant Engineer is present unless you are instructed otherwise. If you have announced your response to an emergency call and your apparatus is about to pull out from the Fire Station, you do not have to stop and yield the right of way to an Engineer or Assistant Engineer that may have just arrived. Less experienced Qualified Drivers should yield the right of way to drive apparatus to a more experienced senior Qualified Driver during emergency responses when possible.

30.    The following protocol shall be followed when repairs are needed to be made to apparatus or equipment on our apparatus;

  1. The Fire Company Engineer should be notified at your earliest convenience anytime a MINOR repair is needed to any apparatus or its equipment. A minor repair is one that does not require a piece of apparatus or equipment to be taken out of service.
  2. The Fire Company Engineer and Chief Officer must be notified IMMEDIATEL when a MAJOR repair is needed that will require a piece of apparatus or equipment to e placed out of service.
  3. It is the responsibility of the Fire Company Engineer or Chief Officer to take apparatus or equipment out of service. Under no circumstance should you as a Qualified Driver resume that responsibility.
  4. In the event you are unable to reach the Fire Company Engineer or Chief Officer, the Officer In Charge may take apparatus or equipment out of service after he or she has exhausted all means of establishing contact with the Fire Company Engineer or Chief Officer.

31.    No repairs should be made to any apparatus by any Fire Company member until the Fire Company Engineer has been advised of the needed repair and authorizes you to fix the apparatus or equipment.

32.    Driver Trainee Candidates and Qualified Drivers are not permitted to take any piece of apparatus out of service to attend any Fire Company function such as a piece of apparatus out of service to attend any Fire Company function such as parade or special event UNLESS permission was obtained through the Board of Trustees first and approval was agreed upon by the general membership during a monthly Fire Company Business Meeting. In the event approval was given to attend such a parade or special event, the Fire Chief should be notified as soon as possible prior to the event date.

33.    The Fire Chief may authorize apparatus to be taken out of service for a local Training class in which our members are participating in.

34.    Headlights on our apparatus should be turned of and used at ALL times for personal safety and visibility even during daylight travel.

35.    It is strongly suggested that a Spotter be used when you are in the process of backing a piece of apparatus anywhere.

36.    NO driver or Driver Trainee Candidates or Qualified Drivers should pull out from dangerous intersections in our jurisdiction such as Snake Hill Rd. and New Holland Pike or Hartman Station Rd. UNLESS those intersections are controlled by Fire Police.

37.    All Driver Trainee Candidates and qualified Drivers should drive in a safe professional manner at all times adhering to all Pa. Motor Vehicle Laws.

 

______________________________________________________________________________

 

Qualification Requirement Completion Date Instructor
1. Driver Training Candidates must successfully pass a 25 question written test by missing no more than 5 questions on the test    
2. Driver Training Candidates must demonstrate and know how the Standard Hydrant Hookup works.    
3. Driver Training Candidates must demonstrate a hydrant hook up using hard suction.    
4. Driver Training Candidates must demonstrate how to Draft water from a pond.    
5. Driver Training Candidates must demonstrate a Tanker Fill operation and know how it works    
6. Driver Training Candidates must demonstrate some type of large diameter hose supply operation to another engine.    
7. Driver Training Candidates must be able to explain and know what all the pump panel gauges are for and what appliances are carried on the apparatus and what they are used for.    
8. Driver Training Candidates must demonstrate operations when multiple hand lines are in use (more than two lines).    
9. Driver Training Candidates must demonstrate how to operate all emergency lighting equipment and audible warning equipment. (Review PA state law procedures pertaining to emergency vehicles)    
10. Driver Training Candidates must demonstrate how to complete an Emergency Vehicle Safety Checklist.    
11. Driver Training Candidates must be able to describe and know how all the equipment on the apparatus works.    
12. Driver Training Candidates must review the Fire Company accident policy and Apparatus/Equipment Repair Policy with the instructor    
13. Driver Training Candidates complete a total of 50 miles of driving on the piece of apparatus they are training on.    
14. Driver Training Candidates must complete a total of 16 hours of pump operations on the apparatus they are training on.    
15. Driver Training Candidates must be able to demonstrate how to start the generator.    
16. Driver Training Candidates must successfully Complete the Driver's Obstacle Course.    

I hereby do certify that the above listed Driver Training Candidate has successfully completed ALL of the Driver Training Qualification Requirements and it is my recommendation to the Fire Chief that the above mention Driver Training Candidate be authorized as a Qualified Driver for the Upper Leacock Fire Company on the following apparatus: __________________________.

Engineer's Signature of Authorization Date

 

______________________________________________________________________________

 

UPPER LEACOCK FIRE COMPANY

Qualification Requirement Completion Date Instructor
1. Driver Training Candidates must successfully pass a 25 question written test by missing no more than 5 questions on the test    
2. Driver Training Candidates must demonstrate and know how to fill SCBA bottles using Cascade system.    
3. Driver Training Candidates must demonstrate knowledge of the work mask air lines.    
4. Driver Training Candidates must demonstrate how to use the remote air fill system.    
5. Driver Training Candidates must demonstrate how to inspect a SCBA bottle.    
6. Driver Training Candidates must demonstrate how to complete an Emergency Vehicle Safety Checklist.    
7. Driver Training Candidates must be able to explain and know how to refill the Cascade System when returning from a call.    
8. Driver Training Candidates must demonstrate how to operate all emergency lighting equipment and audible warning equipment. (Review PA state law procedures pertaining to emergency vehicles)    
9. Driver Training Candidates must have knowledge of the location of all equipment on the apparatus.    
10. Driver Training Candidates must be able to describe and know how all the equipment on the apparatus works.    
11. Driver Training Candidates must review the Fire Company accident policy and Apparatus/Equipment Repair Policy with the instructor    
12. Driver Training Candidates complete a total of 50 miles of driving on the piece of apparatus they are training on.    
13. Driver Training Candidates must complete a total of 8 hours of Cascade operations on the apparatus.    
14. Driver Training Candidates must be able to demonstrate how to start the generator.    
15. Driver Training Candidates must successfully Complete the Driver's Obstacle Course.    

I hereby do certify that the above listed Driver Training Candidate has successfully completed ALL of the Driver Training Qualification Requirements and it is my recommendation to the Fire Chief that the above mention Driver Training Candidate be authorized as a Qualified Driver for the Upper Leacock Fire Company on the following apparatus: __________________________.

Engineer's Signature of Authorization Date

 

______________________________________________________________________________

 

UPPER LEACOCK FIRE COMPANY

Qualification Requirement Completion Date Instructor
1. Driver Training Candidates must successfully pass a 25 question written test by missing no more than 5 questions on the test    
2. Driver Training Candidates must demonstrate how to complete an Emergency Vehicle Safety Checklist.    
3. Driver Training Candidates must demonstrate how to operate all emergency lighting equipment and audible warning equipment. (Review PA state law procedures pertaining to emergency vehicles)    
4. Driver Training Candidates must have knowledge of the location of all equipment on the apparatus.    
5. Driver Training Candidates must be able to describe and know how all the equipment on the apparatus works.    
6 Driver Training Candidates must review the Fire Company accident policy and Apparatus/Equipment Repair Policy with the instructor    
7.Driver Training Candidates complete a total of 5 miles of driving on the piece of apparatus they are training on.    
8. Driver Training Candidates must be able to demonstrate how to start the generator.    
9. Driver Training Candidates have knowledge of Fire Radio    
10. Driver Training Candidates must successfully Complete the Driver's Obstacle Course.    

I hereby do certify that the above listed Driver Training Candidate has successfully completed ALL of the Driver Training Qualification Requirements and it is my recommendation to the Fire Chief that the above mention Driver Training Candidate be authorized as a Qualified Driver for the Upper Leacock Fire Company on the following apparatus: __________________________.

Engineer's Signature of Authorization Date

 

______________________________________________________________________________

 

UPPER LEACOCK FIRE COMPANY

Qualification Requirement Completion Date Instructor
1. Driver Training Candidates must successfully pass a 25 question written test by missing no more than 5 questions on the test    
2. Driver Training Candidates must demonstrate how to complete an Emergency Vehicle Safety Checklist.    
3. Driver Training Candidates must demonstrate how to operate all emergency lighting equipment and audible warning equipment. (Review PA state law procedures pertaining to emergency vehicles)    
4. Driver Training Candidates must have knowledge of the location of all equipment on the apparatus.    
5. Driver Training Candidates must be able to describe and know how all the equipment on the apparatus works.    
6 Driver Training Candidates must review the Fire Company accident policy and Apparatus/Equipment Repair Policy with the instructor    
7.Driver Training Candidates complete a total of 5 miles of driving on the piece of apparatus they are training on.    
8. Driver Training Candidates must be able to demonstrate how to start the generator.    
9. Driver Training Candidates have knowledge of Fire Radio    
10. Driver Training Candidates must successfully Complete the Driver's Obstacle Course.    

I hereby do certify that the above listed Driver Training Candidate has successfully completed ALL of the Driver Training Qualification Requirements and it is my recommendation to the Fire Chief that the above mention Driver Training Candidate be authorized as a Qualified Driver for the Upper Leacock Fire Company on the following apparatus: __________________________.

Engineer's Signature of Authorization Date

 

____________________________________________________________________________

 

DRIVING OBSTACLE COURSE

DRIVER'S OBSTACLE COURSE

The obstacle course is designated to measure the skills of drivers of emergency vehicles. Through its use, training officials can determine the progress each trainee has made over a given period of time. The "Recommended Time" allocated to each vehicle type indicates an ideal score toward which trainees may use as their objective. It may also be used to test present drivers' skills against a norm. the obstacle course is planned to duplicate seven situations in which driver skill, judgment and knowledge of the limitations of his vehicle are required for effective maneuvering. This course of driving tests is listed in the N.F.P.A. Publication # 1002 titled FIRE APPARATUS DRIVER/OPERATOR PROFESSES IONAL QUALIFICATIONS, 1976, in Appendix A. Scoring is based on total time required to complete the course plus the penalties assigned for mis-maneuvers.

NOTE: CREW MAY ASSIST DRIVER IN ALL OBSTACLES EXCEPT STOP SIGN NO. 7.

NAME: __________________________________________________________

COMPANY: ______________________________________________________

VEHICLE: _______________________________________________________

PENALTY SCHEDULE

OBSTACLE NO.

DESCRIPTION

ERROR

PENALTY

No. 1

Straight Line

Each cone brushed, moved or overturned Crossing any line, each time

10 sec.

3 sec.

No. 2

Alley Dock

Each cone brushed, moved or overturned

Crossing any line, each time

Stopping 18" or more short of dock stop

Stopping 12"-17" short of dock stop

Stopping 6"-11" short of dock stop

10 sec.

3 sec.

10 sec.

6 sec.

3 sec.

No 3.

Serpentine

Each pylon brushed, moved or overturned

Failure to stop in time, either end of course

Crossing any line, each time

10 sec.

10 sec.

3 sec.

No 4.

Offset Alley

Each cone brushed, moved, or overturned

Crossing any line, each time

10 sec.

3 sec.

No 5.

Parallel Parking

Each cone brushed, moved or overturned

Crossing any line, each time

If distance from curb line is 12" or more

10 sec.

3 sec.

3 sec.

No 6.

Diminishing Clearance

Each cone brushed, moved or overturned

Crossing any line, each time

10 sec.

3 sec.

No 7.

Stop Sign

Crossing stop line

Stopping 18" or more short of line

Stopping 12"-17" short of line

Stopping 6"-11" short of line

10 sec.

10 sec.

6 sec.

3 sec

SCORE CARD

OBSTACLE NO.

RUN NO. 1

RUN NO. 2

RUN NO. 3

RUN NO. 4

RUN NO. 5

RUN NO. 6

  DATE: DATE: DATE: DATE: DATE: DATE:

1

           

2

           

3

           

4

           

5

           

6

           

7

           

TOTAL PENALTIES

           

DRIVING TIME

           

SCORE

           

INITALS OF SCOREKEEPER

           

UPPER LEACOCK FIRE COMPANY ACCIDENT REPORT GUIDELINES

 

1.

Any driver involved in a motor vehicle accident while operating any of the Upper Leacock Fire Company apparatus will adhere to all guidelines listed below:
  1. When an accident occurs you will immediately pull over to the safest point on the roadway and render aid to any injured person involved.
  2. You will immediately contact County Dispatch and advise them of the situation and request appropriate needs such as EMS, Police, Fire/Rescue, etc.
  3. If you are en route to an emergency/event, you will immediately notify the Chief Officer or Officer in Charge, of that emergency or event.
  4. You are also required to notify the Fire Chief and Fire Company Engineer
  5. Police must be notified of the accident if there were injuries involved in the accident or in the event that damage was done to ANY property or vehicles other than our apparatus.
  6. You are required to submit an approved Upper Leacock Fire Company Accident Report to the Fire Chief and Fire Company Engineer within 24 hours upon returning from the accident.
  7. All accident reports must be filled out completely including items such as: Investigating Officer, Witness Information, Injuries, Damage to all vehicles Involved, Time, Date Location, Weather, Crew on Board, Diagram of Scene, etc. (see enclosed copy of approved accident report)
  8. You are required to see that all parties involved with the accident were given copies of your license information, apparatus registration information, and apparatus insurance information. You are also required to obtain this information from any other drivers involved.
  9. Any driver involved in ANY vehicle accident involving Upper Leacock Fire Company apparatus is suspended immediately from driving any Fire Company apparatus UNTIL the Fie Company Engineer and Chief Officer have completed their investigation of the accident from the Accident Report you submit. All investigations must be completed within 30 days upon receipt of your Accident Report unless certain circumstances arise. If you are the only qualified drive at the scene of the accident, you are permitted to drive the apparatus back to the Fire Station and your suspension of driving privileges would take effect after you have returned.
  10. The Investigating Chief Officer and the Fire Company Engineer have the right to incorporate any outside agency to assist in an accident investigation such as; Police, Accident Reconstructionists, etc.

 

UPPER LEACOCK FIRE COMPANY

ACCIDENT AND DRIVING COMPLAINT REPORT

 

DIAGRAM OF AREA

CALL NUMBER ________ TYPE OF CALL_________

DATE OF INCIDENT _______ TIME OF DAY_______

 

TYPE OF INCIDENT (X all that apply)

 
RESPONDING TO STATION: ________

RESPONDING TO SCENE: ________

AT THE SCENE: ________

RETURNING TO STATION: ________

AT THE STATION: ________

OTHER: ________

 

DRIVER INFO (if applicable)

 
DRIVER GEAR # _____________________________

DRIVER NAME ______________________________

DRIVER OPP # ______________________________

ULFC VEHICLE # ____________________________

 

INJURY INFO (if applicable)

 
INJURIES: ________YES ________NO

# OF CREW INJURED ________

# OF OTHERS INJURED ________

ANY FATALITIES? ________

 

DAMAGE INFO (if applicable)

 

DAMAGES- ON SCALE OF 0 (NONE) - 3(SEVERE)

CONDITIONS

DAMAGE TO ULFC EQUIPMENT: ________

DAMAGE TO OTHER VEHICLES: ________

INITIAL IMPACT POINT:

OUR VEHICLE _____________________________

OTHER VEHICLE ___________________________

APPROXIMATE SPEED:

OUR VEHICLE _____________________________

TYPE OF LIGHTING AT TIME OF INCIDENT: ___________________________________________

WEATHER CONDITIONS AT THE TIME OF INCIDENT: _________________________________

ROAD CONDITIONS AT TIME OF INCIDENT: ____________________________________________

OTHER VEHICLE ___________________________

NAME OF CREW MEMBERS

WAS HAZMAT NEEDED _______ YES _______NO 1. _____________________ SEAT # _____________

INCIDENT LOCATION

2. _____________________ SEAT # _____________
COUNTY __________________________________

TOWNSHIP ________________________________

MUNICIPALITY _____________________________

ROUTE #/ STREET NAME ____________________

TYPE OF ROADWAY________________________

SPEED LIMIT ______________________________

3. _____________________ SEAT # _____________

4. _____________________ SEAT # _____________

5. _____________________ SEAT # _____________

6. _____________________ SEAT # _____________

7. _____________________ SEAT # _____________

8. _____________________ SEAT # _____________

CONSTRUCTION ZONE ________YES ________NO

NAMES OF OTHER PARTY

TRAFFIC CONTROL DEVICE ________YES ________NO 1. ____________________________________________

2. ____________________________________________

OTHER PARTY (if involved)

3. _____________________________________________
OWNER NAME _______________________________________ 4. _____________________________________________
ADDRESS ___________________________________________

WITNESSES

DRIVER NAME _______________________________________

ADDRESS ___________________________________________

OPP # ______________________________________________

YEAR/MAKE _________________________________________

INSURANCE CO. _____________________________________

INS. CO. POLICY # ____________________________________

COMMERCIAL CARRIER ________YES ________NO

CARRIER NAME ______________________________________

ADDRESS ____________________________________________

TYPE OF VEHICLE _____________________________________

1. _____________________________________________

2. _____________________________________________

3. _____________________________________________

4. _____________________________________________

5. _____________________________________________

 

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Page last edited: 03/12/06

© Upper Leacock Fire Company 2003