FFY 2019E-Crash/E-Ticketequipment Grant

New Hampshire Office of Highway Safety

33 Hazen Drive

2nd. Floor, Rm 208

Concord, NH 03305

Telephone: 603-271-2131

Application Form

FFY 2019E-Crash/E-TicketEquipment Grant

Traffic Records

Application due March 30, 2018

Part I Contact Information

Applicant Agency and Street Address
DUNS# / SAM Registration Expiration:
Independent Audit Report (IAR) or Equivalent must be emailed (One audit per dept.) / Date of most recent I.A.R:______
Chief’s First Name / Chief’s Last Name
Chief’s Telephone / Chief’s Email Address
Grant Contact’s First Name / Grant Contact’s Last Name
Grant Contact’s Telephone / Grant Contacts Email Address

Part II Department Community Profile

2015 / 2016 / 2017
Population of your city or town.
Number of full-time officers in your city or town.
Number of part-time officers in your city or town.
Is your department planning for electronic submission of motor vehicle citations? Please circle / Y N / Y N / Y N
Does your department intend to submit electronic criminal complaints to NH DMV? Please circle / Y N / Y N / Y N
Does your department intend to electronically submit crash reports? Please circle / Y N / Y N / Y N
Do you have the necessary IPSECC/VPN connectivity to send and receive J-One messaging with the State of NH Records Management System? Please circle / Y N / Y N / Y N
Were OHS grants received in these years? Please circle / Y N / Y N / Y N
Were all funds used in the years your department received OHS grants? Please circle
If not, please explain why below * / Y N / Y N / Y N
*
Police Departments Ability to Electronically Share/Submit Information
What brand of CAD/RMS system do you use?
Do you dispatch your own calls Yes or No?
Do you own your licenses for CAD/RMS (IMC for instance) Yes or No? If no, who does?
Do you own your server for CAD/RMS (IMC for instance) Yes or No? If no, who does?
Are you connected to someone else’s systemYes or No? If yes, who?
Are you data sharing with other P.D.’s Yes or No? If yes, who?
Are you connected to a hub? Yes or No? If yes, who?
Do you pay your CAD/RMS vendor direct Yes or No? If yes, who do you pay?

Part IIILocal Crash and Enforcement Statistics

This section must be filled out completely for all project applications. If data is unavailable insert (N/A) for not available.

Agency Crash Data / 2015 / 2016 / 2017 / 3 Year Average
Total Crashes (required information)
Injury Crashes
Fatal Crashes

Part IV Total Number of Summonses

Agency Summons Data / 2015 / 2016 / 2017 / Totals
All Traffic Summons (required information)
Part V Equipment Justification (Equipment will only be funded for those departments with an approved NHOHS Enforcement Grant.)
*Important Requirements:
Police Departments shall only use a vendor that has developed software to connect to the state system, (currently there is only one vendor that has developed software to connect to the state system). Police Departments must also have the necessary IPSECCVPN connectivity to send and receive J-One messages to allow for the electronic submission of eCitation/eCrash information using this equipment.
Of those cruisers that are used for traffic enforcement how many are equipped with mobile data terminals? / Quantity
Below are the required types of equipment that can be used to support the e-crash/e-citation program which cannot exceed the amount of a $1,000.00 per unit to include shipping:
UNIT INCLUDES:

Compatible Printer w/Mobile Adapter Kit
Compatible Bar Code Scanner
Compatible USB GPS Receiver

(Does not include additional paper)
How many cruisers would you like this equipment in? (Maximum 5)
NOTE: only cruisers that are primarilyused for citation, crash enforcement and have connectivity to the state system will be considered eligible for this E-Crash/E-Ticket equipment grant.
How will this eCitation/eCrash equipment help with traffic safety enforcement and crash investigation? Please be specific. Equipment must tie into enforcement efforts.
Part VI Project Goals
Please provide your department’s goals for this grant.
Part VII Budget (Not to exceed $1,000.00 per Unit)
Please complete the budget below:
Equipment Name / Number of each / Cost of each
Compatible Printers w/Mobile Adapter Kit / $
Compatible Bar Code Scanner / $
Compatible USB GPS Receiver / $
Shipping / $
Total / $
Match
Note: The match requirement for this project will be met through a police departments own operating budget that will be used to pay for 25% of the equipment cost considered a “Soft Match”.
Please enter your match information below:
Item Quantity / Cost / Total
1. / $ / $
2. / $ / $
3. / $ / $
4. / $ / $
Total amount of Match
Are you receiving any Federal or State grants other than from NHOHS?
YES NO
If “YES” from which agency and for what?

______Chief of Police Signature Date