Chris Hartman Wildland Firefighting Personal Protective Equipment Requests of more than $5,000 Mr Brian Rathgeber PO Box 43 Grainfield, KS 67737 O: 785-673-6023 Mr Chris Hartman PO Box 45 Grainfield, KS 67737 ckhartman68@gmail.com O: 857-719-2478 M: 857-719-2478 Printed On: 25 May 2018 Requests of more than $5,000 1
Chris Hartman Application Form Organization Information Verification of tax-exempt status* Organization is: Government entity Verification of status Please note: Applications from public charities (501(c)3 organizations) are required to attach verification of charitable status in order to be considered. A state sales tax exemption DOES NOT complete this requirement. Applications from churches and/or government entities are not required to attach a verification document. Physical Address If the physical address of your organization is different than the mailing address, please enter your physical address below. 129 E 3rd St Grainfield, KS 67737 Project Information Project Name* Name of Project. Wildland Firefighting Personal Protective Equipment Amount requested* $9,803.19 Primary objectives* The Foundation has six primary objectives. Which of these does your program or project best addresses: Community Social Services & Security Printed On: 25 May 2018 Requests of more than $5,000 2
Chris Hartman County or Counties Served* Please check the primary county served by the program/project for which you are requesting funds. Gove Sheridan Communities Served* Please list the primary community served by the program/project for which you are requesting funds. Our primary community served is Grainfield and the surrounding rural area. We also have mutual aid agreements and routinely provide assistance to our neighboring communities in Gove County, including Grinnell, Park, Quinter, and Gove, as well as Sheridan and Lane Counties. Strategic Doing Project* Was this application generated through the Strategic Doing initiative? No Target Population* Please check one or more populations served by the program/project for which you are requesting funds. All Project Description* Briefly describe the program/project for which you are requesting funds. The Grainfield Volunteer Fire Department is committed to improving our ability to fight wildland fires. We are responsible for fires in our service area surrounding the City of Grainfield, and we also routinely provide mutual aid to neighboring departments in Grinnell, Gove, Quinter, and in Sheridan and Lane Counties. In addition, we send equipment and manpower to more distant wildland fires when requested, for example the devastating Anderson Creek fire in Barber County in 2016. We are very proud of the commitment shown by our volunteer firefighters, who are on standby and ready to serve their community 24 hours a day, 365 days a year. Our volunteer firefighters freely give of their time and risk personal harm in order to protect others. Although they are not salaried, our volunteer firefighters approach their jobs as professionals, improving their skills at events such as the Kansas State Firefighters Association two-day training which was hosted by the Grainfield Volunteer Fire Department and held at Wheatland High School in Grainfield. The best way for our community to compensate our volunteer firefighters for their time and commitment is to ensure that they have the best possible equipment to protect their life and health. Grant Request Description* If funded, how will you specifically use the Dane G. Hansen funds? Printed On: 25 May 2018 Requests of more than $5,000 3
Chris Hartman This request for funding is to allow the Grainfield Volunteer Fire Department to purchase 15 complete sets of Wildland Personal Protective Equipment (Wildland PPE) for our volunteer firefighters. Project Objectives* What do you hope to achieve and how will it benefit the people of Northwest Kansas? The overall objective of this project is to improve the effectiveness of our wildland firefighting efforts, now and into the future. We can accomplish this, in part, by better protecting the health and safety of our volunteer firefighters so that they can focus on putting out fires rather than contend with inadequate equipment. Firefighting is inherently dangerous, but health and safety can be significantly improved with the use of proper and up-to-date equipment. Minimizing the chance of firefighter injury or death helps ensure that our roster of volunteer firefighters can always operate at full strength. It also minimizes the costs to taxpayers. 1. Provide needed equipment. Currently our volunteer firefighters lack certain pieces of PPE that are specifically designed for wildland firefighting. These include helmets, goggles, face masks with filters, gloves, and boots. 2. Replace PPE that has outlived its useful service life. The wildland PPE garments currently in use consist of lightweight jumpsuits. These garments are old and have outlived their useful service life according to National Fire Prevention Association (NFPA) standards. We propose to replace these jumpsuits with jackets and pants. 3. In addition to the all-important goal of improving safety for our firefighters, these garments offer greater flexibility and freedom of movement, which will increase efficiency on the fireground and enable our firefighters to more effectively combat wildfires. In addition, a significant portion of our service calls involve motor vehicle accidents, where we assist with extrications and provide traffic control. In these situations we are actually hampered by the weight our heavier bunker gear, which is primarily designed for fighting structure fires. The ability to don lightweight wildland PPE in these situations will improve our efficiency effectiveness in these situations. Timetable for the Project* When is the project projected to begin and end? For ongoing projects, when will the Dane G. Hansen funds be utilized? The Wildland PPE will be purchased and put into service as soon as funding can be secured. With normal use we expect this equipment to last 10 years before NFPA standards require us to replace the equipment. Additional Support Describe additional sources of support (if any) that have been secured or that will be pursued for this project. We are also pursuing funding from the Gove County Community Foundation, an affiliate of the Greater Northwest Kansas Community Foundation, as well as the National Volunteer Fire Council. The grant applications for these funding sources are currently in process. In the event that we exceed our fundraising goal for this project, any excess funds will be returned. Printed On: 25 May 2018 Requests of more than $5,000 4
Chris Hartman Evaluation* How will you evaluate the success of the project/program? Be specific. (If funded, this will be helpful when completing the final grant report.) Proper equipment not only reduce our ISO rating, which would directly affect our insurance rates, but it would better protect the volunteers who risk their lives day and night, 365 days a year to protect agricultural land, homes, and those that travel through our Gove County on Interstate 70. With weather trends that continue to be very dry, the frequency of fires (and their intensity) continues to climb. In a small rural community, the volunteer fire department is vital to protect our acres of crops, livestock, businesses, homes, and most importantly our people. Sustainability* How will the project/program be sustained in the future? (For capital projects, how will you maintain or operate the item or facility?) Proper cleaning and maintenance of all equipment whether PPE, vehicles, tools, or hoses is part of any fire department s normal work routine. The Grainfield Volunteer Fire Department has laundry facilities in its Fire House which will be used to ensure that the PPE is properly maintained so that it can provide effective service throughout its entire lifespan. Supporting Documents Proposal Budget* Complete the budget form attached on the Grant Criteria page under document requirements and upload here. DGH-Wildland PPE Budget-Sheet-1.xlsx Balance Sheet* A detailed financial statement is required. Please do not attach your entire audit report. An example can be found on the Grant Criteria page, under document requirements. Grainfield VFD Balance Sheet.pdf Income Statement* A detailed financial statement is required. Please do not attach your entire audit report. An example can be found on the Grant Criteria page, under document requirements. Grainfield VFD Income Statement.pdf Board of Directors* Please attach a list of your board members. (Name and title, no biographies.) Grainfield VFD Board of Directors.pdf Printed On: 25 May 2018 Requests of more than $5,000 5
Chris Hartman Bid or Quote A copy of the bid or quote is required for a capital project or purchase. Wildland PPE Quote - Hays Fire and Rescue.pdf Letter of Support 1 A letter of support may be attached, but is not required. Gove County EM Letter - Wildland PPE Grant.pdf Letter of Support 2 A second letter of support may be attached, but is not required. Gove County Commission Letter - Wildland PPE Grant.pdf Letter of Support 3 A third letter of support may be attached, but is not required. Grainfield City Council - Wildland PPE Grant.pdf Additional Documents If there are additional documents that are critical to the trustees understanding of your proposal, upload them here. Electronic Signature Signature of Applicant* By entering my full legal name here, I warrant the truthfulness of the information provided in this application. Christopher Hartman Title of Applicant* Firefighter and Financial Manager Signature of Principal or College President (if required) By entering my full legal name here, I warrant that I have read and support this application. Printed On: 25 May 2018 Requests of more than $5,000 6
Chris Hartman Title of Principal or College President Signature of CEO, Director, Mayor, etc. If this request is for a City, 501 (c)(3) Organization, Government Entity, etc., the signature of the CEO, Director, Mayor, etc., is required. By entering my full legal name here, I warrant that I have read and support this application. Harvey Heier Title of CEO, Director, Mayor, etc. Mayor Internal Tracking Number* 2018-6-30 501c3* Yes Printed On: 25 May 2018 Requests of more than $5,000 7
Chris Hartman File Attachment Summary Applicant File Uploads DGH-Wildland PPE Budget-Sheet-1.xlsx Grainfield VFD Balance Sheet.pdf Grainfield VFD Income Statement.pdf Grainfield VFD Board of Directors.pdf Wildland PPE Quote - Hays Fire and Rescue.pdf Gove County EM Letter - Wildland PPE Grant.pdf Gove County Commission Letter - Wildland PPE Grant.pdf Grainfield City Council - Wildland PPE Grant.pdf Printed On: 25 May 2018 Requests of more than $5,000 8
Dane G. Hansen Project Budget Form Organization: Grainfield Fire Department Project name: Wildland PPE List project expenses (be specific) Face Masks HotShield Wildland: 15 @ $76.95 each $1,154.25 Wildland Helmets: 15 @ $47.95 each $719.25 Nomex Ear/Neck Protection - Long: 15 @ $33.00 each $495.00 Wildland Gloves: 15 @ $14.95 each $224.25 Goggles: 15 @ $15.95 each $239.25 Wildland Boots Cosmas: 15 @ $320.95 each $4,814.25 Wildland Coats Veridian Nomex: 15 @ $298.87 each $4,483.05 Wildland Pants Veridian Nomex: 15 @ 241.67 each $3,625.05 Shipping (Estimate) $250.00 *Total Project Expenses $16,004.35 Project Revenue Secured Applied-for Earned In-kind donations can be included- provide equitable dollar amount. Budgeted funds, gifts received, etc (Grants, Pending donations) Dane G. Hansen Foundation Request $9,803.19 (Fees, ticket sales, etc) Gove County Community Foundation $0.00 $4,201.16 $0.00 National Volunteer Fire Council $0.00 $2,000.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTALS $0.00 $16,004.35 $0.00 *Total Project Revenue $16,004.35 *Revenue and Expense totals should be the same.
Grainfield Volunteer Fire Department Board of Directors Brian Rathgeber Fire Chief Derek Herl Assistant Fire Chief Jack Farber Training Officer