Request for mobile radio installation or removal




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State of California

California Governor's Office of Emergency Services



REQUEST FOR MOBILE RADIO INSTALLATION OR REMOVAL

TDe-213 (REV. 11/2014)




PUBLIC SAFETY COMMUNICATIONS




Date:

     

Vehicle VIN:

     

PSC Agency Billing Code:

 

 

 

 

 







(Last 5 Digits of Vehicle VIN)

(Required)




Optional Agency Tracking Number:

     




Agency / Institution Code:

 

 

 

-

 

 

 

(For Agency Use ONLY – 10 Digits Max) (For PSC Use ONLY)




Agency Representative

     




Comment:

Address

     




     

City / Zip

     




Telephone

     




Vehicle Location

     










Service Provider

     




Address

     




City / Zip

     




Telephone

     










Technician

     

DC#

    




(For PSC Use ONLY)



Requested Start Date of Service:

     

Actual Completion Date of Service

     



Authorization to perform work on the following vehicle:

Year

    

Make/Type

     

License

     

Unit

     



Equipment to be installed or removed:




Serial #




PSC

Service No.






Agency

Property No.



Inst




Rem




Type




Manufacturer/Model




















     




     




     




     




     











     




     




     




     




     











     




     




     




     




     



Work to be performed shall be limited to those items checked on the following list:

Inst




Rem







Inst




Rem




Inst




Rem











At agency site, 10-60 miles




 




 

Glass or roof mount antenna








Concealed control head/mic








At agency site, 61-120 miles











Disguise cowl-mount antenna








Concealed trunk radio unit








At agency site, over 120 miles











Pillar spotlight








Concealed headliner mic assy

 




 

Trunk mount radio











Overhead spotlight








Concealed siren switch

 




 

Front mount radio











Power Tamer

 




 

Rear light defeat toggle switch

 




 

Heavy equipment radio











Neutral tap

 




 

Shotgun rack & lock








Scanner receiver











Electronic siren, complete








Shotgun release button/timer








PA System with speaker











Lightbar








MDT / Computer Mount








Radio outside speaker











Wig-wag flasher, complete








Pistol lock box








Cellular hands-free kit











Arrow stick with controller








Molded rear seat








Portable radio charger system











Rear warning lights, complete








Protective screen








Radio console











Rear strobes (undercover only)








Window bar set








Map reading light











Front corner strobes








Door pop








Portable radio charger system with linear amp











Red/blue flashing light behind vehicle grill, complete








Door skins








Flashlight holder











Front mirror light








Push bumper








PA mic jack











Tape recorder jack








Window drop








Speaker mute switch











Back flash








Fan

 




 

Aux switch











Kennel








Heat / stall sensor








Hourly Installation Rate (HIR) Labor

(Explain in comments box, above)




Hours Authorized

     






If HIR box is checked, vendor must provide a

Pre-Installation Client Request form (TD-215) w/invoice.





Agency Authorization




PSC Area Supervisor Authorization

Print Name:

     




Print Name:

     

Signature 







Signature 




Date

     




Date

     



Upon completion of service forward this form to the following address:

Public Safety Communications, Attn: Billing Unit, 601 Sequoia Pacific Blvd., Sacramento, CA 95811-0231


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