Instructionsfor MOU and Sample by yRKfBim


									                                  Instruction Sheet for Facilities
                      Attached Memorandum of Understanding (MOU) Template

1. The attached MOU template is not intended to be legally binding on the parties. Rather, the intent is to

    establish an advance relationship between a facility in need of resources and a company who may have

    resources and is willing and able to provide assistance during a declared emergency or disaster. It is

    important to recognize that, even if an MOU has been signed by the parties, resources are always

    subject to availability and a company’s prior commitment. Thus, it is good planning to have more than

    one MOU with companies that may be in a position to provide particular goods or services. Don’t

    become discouraged if you are unable to find companies who are willing to sign an MOU to provide

    resources. Every community is different. Be resourceful. If a company does not agree to assist your

    facility, find another source, or negotiate more reasonable amounts of goods or services. Please also

    keep in mind that, although you may want to secure as much of a particular resource as you can, the

    company always has the right to ration supplies. Be respectful and reasonable in your requests and


2. During a declared emergency or disaster, many retail companies with large amounts of stock will choose

    to help their communities recover quickly by making available water, tarps, construction supplies, etc.

    Although some companies may donate good and services, it is more likely that your facility will be

    required to pay for needed resources. Because of this it is critical for the facility to keep sufficient

    emergency cash reserves secured onsite and available for use in the event of a disaster. Also, keep in

    mind that credit cards may not work if a major emergency or disaster strikes. Before you approach a

    company that has resources you need, fill in the bold font, bracketed portions of the template, deleting

    BOLD FONT wording in the brackets. Be aware that some companies have their own MOUs or

    Memorandum of Agreement (MOAs) available to use.

3. Facilities are strongly urged to consult with an attorney of their own choosing and their insurance carrier

    before electing to use the attached Memorandum of Understanding (MOU) template. The Colorado
Department of Public Health and Environment /Health Facilities and Emergency Medical Services

Division, is not responsible for any facilities’ agreements or emergency operations plans.
                                     Memorandum of Understanding


                                      (Insert Facility Name Here) and
                                       (Insert Company Name Here)

1. Introduction
   During times of emergencies, critical functions (water, gas and electric utilities) and infrastructures
   (governments and communities) may not be working or may be only providing minimal services. Some
   facilities such as this one may require assistance with water supply, transportation, delivery of food or
   medications, temporary alternative shelter, or with other important functions. This facility is planning
   ahead for those times and seeks your assistance so that it may better provide for the health, safety and
   welfare of facility residents.

2. Parties
   This Memorandum of Understanding is entered into by the parties for the purpose of acquiring
   resources from (insert full name of company here) located at (insert full address here) and (insert
   name of assisted living facility as it appears on the license) located at (insert full address here), a duly
   licensed assisted living residence that provides care and services to vulnerable adults.

3.    Purpose
     This MOU is not intended to be legally binding. Rather, it is an advance agreement whereby, subject to
     availability, (INSERT COMPANY NAME HERE) agrees to provide needed goods and services to (INSERT
     LICENSED FACILITY NAME HERE) for the benefit of and use by facility residents during a declared
     emergency or disaster.

     A declared emergency or disaster is an event or incident such as a facility fire, gas explosion resulting in
     severe damage to the facility, tornado resulting in severe damage to the facility, bomb threat resulting
     in evacuation of the facility, loss of services to the facility such as power outage, gas outage, or water
     outage, or a community-wide disaster declared as such by local, state or federal authorities which
     threatens to create severe hardship for facility residents.

   Subject to availability, (INSERT COMPANY NAME HERE) agrees to provide one or more of the following:
   (Insert what the facility needs here that this particular company can provide and delete the rest:
   Water, equipment, transportation, shelter, etc., for instance, one pallet of bottled water, or if the
   facility needs transportation, one bus with a handicap lift with and driver.)

5. There are no monetary agreements pursuant to this MOU between (INSERT COMPANY NAME HERE) and

   much information regarding all related emergency event activities, including providing the company as
   much notification time as possible regarding the facility’s needs for the agreed upon resources. If
   possible, such information will include a tentative timeframe when the facility expects the emergency to
7.   Activation
     In the event of a declared emergency or disaster an authorized representative of (INSERT LICENSED
     FACILITY NAME HERE) will contact (INSERT COMPANY NAME HERE) or other key staff of the company
     to request needed goods and services under this MOU.

8.    Implementation and Term
     This MOU shall take effect upon its signing by all parties. This MOU may be amended at any time by
     mutual agreement of all parties. All parties will conduct an independent review this MOU on an annual
     basis. This MOU shall remain in effect until terminated by written notification from one party to

     Agreed and Accepted to:

     (Name of Facility)                                    (Name of Corporation or Company)
     (Person of Authority)                                 (Name of manager, president, etc.)

     Sign: ___________________________________          Sign: _______________________________

     Print Name: ______________________________             Print Name: _________________________

     Date: ___________________________________          Date:______________________________

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