STATE OF CALIFORNIA, THE NATURAL RESOURCES AGENCY
RESITA TIR ROTTENCE DEPARTMENT OF FORESTRY AND FIRE PROTECTION (CAL FIRE) CAL
FIRE APPLICATION FOR PARTICIPATION
SINCE 1885 FIREFIGHTER PROPERTY (FFP) PROGRAM
NEW UPDATE L SCREENER ID (Update Only):
Date of Application:
COOPERATOR INFORMATION
Cooperator Name: City of Merced Fire Department
Physical Address (No P.O. Box): 99 E. 16th Street
Mailing Address (If different from
above):
City: Merced
County: Merced
Zip Code: 95340
Phone Number: 2093856891
Fax Number:
Fire Cooperator Email: [email protected]
COOPERATOR'S FIRE CHIEF'S INFORMATION
Title: Fire Chief
Name: Derek Parker
Email: [email protected]
Phone Number: 2093858541
Cell Phone Number: 2096002814
COOPERATOR'S FFP POINT OF CONTACT (POC) / SCREENER
Designated Point of Contact/Screener does not have to be Fire Chief. The POC must be an individual who may be easily reached to coordinate with CAL FIRE
Title: Fire Chief
Name: Derek Parker
Email: [email protected]
Phone Number: 2093858541
Cell Phone Number: 2096002814
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I certify that I have read and understood the FFP Program Guide for Cooperators to participate in the Firefighter Property Program (Title 10 U.S. Code § 2576b).
I certify that appropriate local funding will be made available to transport, repair, maintain, retrofit and refurbish FFP equipment to comply with the placed in service deadline of one (1) year from the date acquired property is picked-up from Department of Defense (DoD) Disposition site and returned to Local Fire Cooperator's site.
* This application must be updated and resubmitted within 30 calendar days whenever there is a change in either of the following:
1. Local Fire Cooperator's name, mailing and physical address, contact numbers (direct phone and fax) and email;
2. Fire Chief's information: name, contact numbers (direct phone and cell phone) and email; Main Point of Contact for FFP Screeners and FFP general information: name, contact numbers (direct phone and cell phone) and email.
COOPERATOR
NAME OF FIRE DEPARTMENT:
City of Merced Fire Department
BY (Authorized Signature): DATE SIGNED:
PRINTED NAME AND TITLE OF PERSON SIGNING:
Derek Parker
Note: This section filled out by Sacramento FFP Program Office & USES
STATE OF CALIFORNIA
Department of Forestry and Fire Protection (CAL FIRE)
APPROVED DENIED
BY (CAL FIRE BUSINESS SERVICES OFFICE): DATE SIGNED:
PRINTED NAME AND TITLE OF PERSON SIGNING:
Alicia Hastings, Federal Property Coordinator
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