Arizona City Fire District
Person's Name Completing this Form
Shirley Sutherland
Organization Name
Arizona City Fire District
Complete Mailing Address
Arizona City Fire District Attn: Shirley Sutherland P.O. Box 6 Arizona City, AZ 85123
Email: shirley.sutherland@azcityfire.com
Phone 5204665542
Detail PEDIATRIC Equipment/Medical Supplies to be Purchased and Its Estimated Cost 2024 Updated PALS Dose By Growth Pediatric Advanced Life Support Em ergency Length-Based Tape with Broselow Compatible Color Zones Desig ned for Paramedics, Nurses & EMS Providers $29 per unit x 32 units = $92 8.00 plus tax 6.7% = $990.18
*
Indicate Amount of Funding Requested. Limit is $1,000 $ 990.18
Name of Authorized Organization Contact Signing this Form
Shirley Sutherland
Date 2024-04-17
Regional Fire & Rescue Dept.
Person's Name Completing this Form
John Bayles
Organization Name
Regional Fire & Rescue Dept.
Complete Mailing Address
7951 W. McCartney Rd Casa Grande, AZ 85194
Emailj
ohn.bayles@regionalfire.org
Phone
520-723-4680 x 107
Detail PEDIATRIC Equipment/Medical Supplies to be Purchased and Its Estimated Cost
We would like to purchase the following items for our ped-ready kits within our response boxes. G3+ quick roll intubation Kits: $70.00 each total of $14 0.00 G3+ Circulatory Kit: $55.00 Each total of $110.00 G3+ Medicine Cell: $159.00 each total of $636.00 For a grand total of $886.00. These items wil l be carried to place pediatric supplies in their own containers to separate fr om adult supplies.
Indicate Amount of Funding Requested. Limit is $1,000 $ 886.00
Name of Authorized Organization Contact Signing this Form
John Bayles
Date 2024-04-30
Superior Fire Dept
Person's Name Completing this Form
Bonnie Lusk
Organization Name
Superior Fire Dept
Complete Mailing Address
PO Box 218 Superior, Arizona 85173
bmariscal@superioraz.gov
Phone 6023619610
Detail PEDIATRIC Equipment/Medical Supplies to be Purc hased and Its Estimated Cost
Emergency Child Restraint, Biothane ea. 959. 00
Indicate Amount of Funding Requested. Limit is $1,000 $ 959.00
Name of Authorized Organization Contact Signing this For m
Bonnie Lusk
Date
2024-04-30