HomeMy WebLinkAboutRegion 7 Healthcare Mutual Aid AgreementRegion 7 Healthcare Coalition MOD 4/15/2010
REGION 7 HEALTHCARE
MUTUAL AID AGREEMENT
Revised: April 21, 2009
This Region 7 Healthcare Inter-Jurisdictional Mutual Aid Agreement ("Agreement") is made and
entered into by the signatory Healthcare Agencies within Region 7 in the State of Washington
that operate a Hospital or Clinic individually with all other signatory Party Healthcare agencies
legally joining the Agreement.
PURPOSE
The undersigned Parties confront numerous threats to the public's health, including but not
limited to, Public Health Incidents, Emergencies andlor Disasters that could overwhelm the
capabilities of an immediate local response. None of the Parties to this Agreement possesses all
of the necessary resources to cope with every possible Public Health Incident, Emergency or
Disaster by itself, and a more efficient, effective response can best be achieved by the application
and leveraging of collective resources.
Each Party desires to voluntarily aid and assist each other by the interchange of health care
resources and services in the event that a Public Health Incident, Emergency or Disaster situation
should occur. The Party finds it necessary and desirable to execute this Agreement for the
interchange of such mutual Assistance on a county and/or regional basis.
The Parties to this Agreement have determined it is in their collective best interest to develop and
implement a Plan, and incorporate mutual aid response into their existing emergency response
plans. Training and exercising Mutual Aid protocols, in advance of a Public Health Incident,
Emergency or Disaster, will enhance the efficiency and effectiveness of each responding party.
The Parties desire to cooperate with one another to receive state and/or federal resources,
provided such cooperation does not compromise a Parties own healthcare response. The Parties
desire to engage in frequent consultation and to allow free exchange of information, plans, and
resource records related to Assistance activities.
ARTICLE I
DEFINITIONS
Assistlng Party: A Party providing Assistance to a Requesting Party from another healthcare
agency that has requested Assistance to confront a Public Health Incident, Emergency or
Disaster.
Assistance: Assistance means personnel, equipment, materials, supplies, facilities, services,
andlor related resources.
Authorized Representative: The person or persons designated by each Party in the Plan to request
Assistance from or grant Assistance to another Party pursuant to the terms of this Agreement.
Mutual Aid: A prearranged written Agreement and Plan whereby Assistance is requested and
may be provided between two or more healthcare jurisdictions during a Public Health Incident,
Emergency or Disaster under the terms of this Agreement.
MuluallvAgreed Upon : As it pertains to the "Withdrawal of Assistance" in Article VI. A
condition or set of conditions that both parties verbally conclude to be fair and appropriate prior
to agreeing to send or receive resources, with a written document to follow in a timely manner.
Period o(Assistallce : The period of time beginning with the departure of any personnel,
equipment, materials, supplies, services, and/or related resources of the Assisting Party from any
point for the purpose of traveling to provide Assistance exclusively to the Requesting Party, and
ending on the return of all of the Assisting Parties personnel, equipment, materials, supplies,
services, and/or related resources to their regular place of work or assignment, or otherwise
terminated through written or verbal notice of the Authorized Representative of the Assisting
Party With respect to facility use, the Period of Assistance shall commence on the date agreed
upon between the Requesting and Assisting Party and shall end when the Requesting Party
returns possession of the facility to the Assisting Party, or when otherwise terminated through
written or verbal notice of the Authorized Representative ofthe Assisting Party.
Plan: a written regional healthcare inter-jurisdictional Mutual Aid Plan that meets the
requirements set forth in Article VII.
Public Heallh Incident. Emergency. or Disaster: Any occurrence, or threat thereof, whether
natural or caused by man, in war or in peace, to which any Party may respond pursuant to its
authority under chapter 70.05 or 70.46 RCW, or other applicable law, and that, in the judgment
of the Requesting Party, results or may result in circumstances sufficient to exceed the
capabilities of immediate local or regional healthcare response.
Portal to Portal Method: The Assisting Party's resources compensable time starts at the moment
the resource leaves the Assisting Party's location and concludes when that resource returns to
this same location.
R e.questingParty: A Party that has requested Assistance from a Party from another healthcare
agency participating in this Agreement.
ARTICLE II
IMPLEMENTATION
This Agreement shall become effective immediately upon its execution by any two Parties. After
the first two such executions, this Agreement shall become effective as to any other Parties in
Region 7 in the State of Washington upon its execution by such Party. The Agreement shall
remain in effect as between each and every Party until participation in this Agreement is
terminated by a withdrawing Party in writing pursuant to Article XVII. Termination of
participation in this Agreement by a withdrawing Party shall not affect the continued operation
of this Agreement as between the remaining Parties.
ARTICLE III
PARTICIPATION
The Parties have a desire to be of help to one another in response to a request for Assistance
related to a Public Health Incident, Emergency or Disaster. The Parties agree that this
Agreement, however, does not create a legal duty to provide Assistance. The Parties agree that
any and all actions taken pursuant to this Agreement shall be voluntary. A Party may elect to
voluntarily furnish such Assistance to another Party as is available, and shall take into
consideration whether such actions might unreasonably diminish its capacity to provide basic
health services to its own locale.
ARTICLE IV
HOW TO INVOKE ASSISTANCE
The Authorized Representative of a Party may request Assistance of another Party by contacting
the Authorized Representative ofthat Party. The provisions of this Agreement shall only apply to
requests for Assistance made by and to Authorized Representatives or their designee. Requests
may be verbal or in writing. If verbal, the request shall be confirmed in writing before the Period
of Assistance begins to the extent it is practical.
ARTICLE V
LIABILITY RELATED TO DELAY OR FAILURE TO RESPOND
No Party shall be liable to another Party for, or be considered in breach of or default under this
Agreement on account of any delay in or failure to perform any obligation under this Agreement,
except to make payment as specified herein.
Nothing in this Agreement shall be construed to create any rights in or duties to any third party,
nor any liability to or standard of care with reference to any third party. This Agreement shall not
confer any right or remedy upon any person other than the Party. This Agreement shall not
release or discharge any obligation or liability of any third party to any Party.
ARTICLE VI
WITHDRAWAL FROM ASSISTANCE
An Assisting Party may withdraw Assistance by giving verbal or written notice to the Requesting
Party. Each Assisting Party that is providing Assistance to a Requesting Party agrees to give
reasonable notice to the Requesting Party under the circumstances as they exist at the time before
withdrawing Assistance. No Party shall be liable to another Party for, or be considered in breach
of or default under this Agreement on account of, any withdrawal of assistance.
The Requesting Party, at the time a resource request is made shall make every effort to notify the
Assisting Party of the intended time a resource is needed. By sending a resource, the Assisting
Party agrees to the requested time frame or shall clarify this point with the Requesting Party prior
to resource departure, if alternate time frames are desired.
If an Assisting Party's resource needs to depart an assignment prior to the agreed upon time
frame the Assisting Party will make every effort to supply a replacement and avoid a gap in the
service provided by the resource. Ifthe Assisting Party is unable to supply a substitute resource
in a timely manner, they are requested to work with other hospitals or agencies to make every
effort to replace said resource, but all parties must understand that resources may be in short
supply during a crisis.
ARTICLE VII
PLANNING, MEETING AND TRAINING
Parties are expected to:
1) ensure that other Parties have their most current contact information;
2) participate in scheduled meetings to coordinate operational and implementation matters,
and
3) participate in Region 7 Healthcare Coalition emergency response planning.
4) pre-deployment training shall insure that assisting employees are aware of their
obligation to inform their requesting party's immediate supervisor in the command
structure if dangerous conditions exist, or if the assignment is not appropriate or if the
assignment is inconsistent with safety regulations or their training. Said pre-deployment
training is the responsibility of the Assisting Party, prior to resource departure.
Curriculum for such training will be provided by the Region 7 Healthcare Coalition
covered in Annex E.
Parties agree to incorporate protocols related to this Agreement into regular emergency
preparedness exercises and trainings, and will train in accordance with the Plan. Requesting
Parties agree to provide "Just In Time Training" during Public Health Incidents, Emergencies or
Disasters on their policies, procedures and protocols for Assisting Parties personnel. Parties
agree to exchange their emergency preparedness plans, and other documents that may be
beneficial in preparing personnel from another Party to respond to a request for Assistance.
ARTICLE VIII
COMMAND AND CONTROL
Resources from the Assisting Party shall be under the operational control of the Requesting
Parties emergency leadership . All personnel provided by an Assisting Party will be under the
authority of the Local Health Officer in the Requesting Parties jurisdiction, and under the
direction ofNIMS the Assisting Party's resources are working for the Requesting Party's
Incident Commander. The Party intends to follow the National Incident Management System's
"Incident Command System" when such system is activated. The ultimate responsibility for
resource tracking falls upon the Requesting Party.
ARTICLE IX
ASSISTING PARTY EMPLOYEES
Employees of an Assisting Party shall at all times while performing Assistance continue to be
employees of the Assisting Party for any purpose. Wages, hours and other terms and conditions
of employment of Assisting Party shall remain applicable to all of its employees who perform
Assistance under this Agreement. Assisting Parties shall be solely responsible for payment of its
employees' wages, any required payroll taxes and any benefits or other compensation.
Requesting Party shall not be responsible for paying any wages, benefits, taxes or other
compensation to Assisting Parties employees.
ARTICLE X
INJURY COMPENSATION AND DEATH BENEFITS
Each Party shall provide for the payment of Workers' Compensation benefits to its own injured
personnel and/or to representatives of its own personnel in case such personnel sustain injuries or
are killed while rendering aid under this Agreement, in the same manner and on the same terms
as if the injury or death were sustained within its own jurisdiction.
Nothing in this Agreement shall abrogate or waive any Parties right to reimbursement or other
payment available from any local, state or federal governments or abrogate or waive the effect of
any waiver, indemnity or immunity available to a Party under local, state or federal law or other
governmental action. To the extent that such reimbursement, payment, waiver, indemnity or
immunity does not apply, then each Party shall remain fully responsible as employer for all
taxes, assessments, fees, premiums, wages, withholdings, Workers' Compensation, and other
direct and indirect compensation, benefits, and related obligations with respect to its own
employees. Each Party shall provide Workers' Compensation in compliance with the statutory
requirements of the State of Washington.
ARTICLE XI
REIMBURSEMENT OF COSTS AND CONDITIONS OF LOAN
The Requesting Party agrees to reimburse the Assisting Party for the costs of personnel,
equipment, materials, supplies, facilities, services, and/or related resources used during the
Period of Assistance on the basis of mutually accepted costs associated with these resources.
When an Assisting Party deploys employees under the terms of this Agreement to a Requesting
Party, the Assisting Party will be reimbursed by the Requesting Party equal to the Assisting
Parties full cost, including employee's salary or hourly wages, call back or overtime costs,
benefits and overhead, and consistent with the Assisting Parties personnel union contracts, if any,
or other conditions of employment.
Assisting Parties will bill for supplied resources using the Portal to Portal method.
Specialized resources or equipment, supplied by the Assisting Party may need to be supplied
with a technician to operate or train emergency users. Such situations will be discussed by both
parties prior to dispatch and appropriate costs and time frames will be agreed upon prior to
dispatch of said resources.
Basic accommodations, covering nutrition and sleeping arrangements for the Assisting Party's
resources will be discussed and agreed upon prior to dispatch.
Reusable materials and supplies that are returned to the Assisting Party in clean, damage free
condition, excepting normal wear and tear, shall not be charged to the Requesting Party and no
rental fee shall be charged. The Assisting Party shall determine whether items are returned in
clean and damage free condition, and any items found to be damaged shall be treated as partially
consumed and/or as non-returnable materials and supplies. Equipment and supplies shall be
billed at the dollar amount it costs the assisting party to purchase the supplies originally.
The Assisting Party shall be entitled to receive payment for the cost of repair or replacement of
damaged and consumed materials and supplies. The Assisting Party shall send the Requesting
Party an invoice or invoices for all valid Assistance Costs within 30 days of incurred cost, and
the Requesting Party shall pay the invoice( s) within sixty (60) days of receipt of each invoice.
The actual cost associated with sending resources will be invoiced and paid, but a provision will
be included that allows the requesting party to challenge a bill, if a charge exceeds established
current market place valuation of product or service.
ARTICLE XII
WORKER REGISTRATION, LIABILITY AND DISPUTE RESOLUTION
1. WORKER REGISTRATION AND LIABILITY. The Parties to this Agreement agree
that each will take all actions necessary to qualify and maintain qualification of its own
personnel, employees and volunteers as emergency workers, or covered volunteer
emergency workers, to the eXtent possible and as appropriate, pursuant to RCW 38.52 et
seq., WAC 118-04 et seq., and any other applicable statute, regulation or law. The Parties
agree that prior to invoking a request for Assistance under this Agreement for a large
event, the Requesting Party through its local department of emergency management; will
request the issuance of a mission number from the Washington military department,
emergency management division. A Party may condition its willingness to respond and
the continuance of its response under this Agreement on. the issuance of a mission
number, and compliance with RCW 38.52 et seq., WAC 118-04 et seq., or other law, by
the Assisting and Requesting Party.
2. In the event local, state and/or federal governments or laws provide waiver, immunity,
indemnification, reimbursement or other payment related to liability that would otherwise
be the responsibility of a Party then such waiver, immunity, indemnification,
reimbursement or other payment shall limit a party's liability. The Parties agree to
exhaust their rights to waiver, immunity, indemnification, reimbursement or other
payment from local, state, and/or federal governments. However, to the extent that local,
state or federal governments or laws do not provide complete waiver, immunity,
indemnification, reimbursement or other payment related to Party liability, then the
following provisions will apply:
A. Each party to this Agreement shall be legally responsible for its own acts and
omissions arising under this Agreement, and that of its respective appointed and
elected officials, employees, officers, agents, agencies, assigns and
representatives. Each party agrees to defend, indemnify, and hold harmless the
other party, and its respective appointed and elected officials, employees, officers,
agents, agencies, assigns and representatives from and against any and all
liability, loss, cost, damage and expense arising or alleged to have arisen directly
or indirectly out of or in consequence of the performance of this Agreement by
the indemnitor.
B. GROSS NEGLIGENCE OR WILLFUL OR WANTON MISCONDUCT. Any
Party shall not be required under this Agreement to release, indemnify, hold
harmless or defend any other Party from any claim, loss, harm, liability, damage,
cost or expense caused by or resulting from the activities of any Parties officers,
employees, or agents acting in such a manner that constitutes willful misconduct,
gross negligence or bad faith.
C. LIABILITY FOR PARTICIPATION. In the event of any liability, claim, demand,
action or proceeding, of whatever kind or nature arising out of the rendering of
Assistance through this Agreement, the Requesting Party agrees, to indemnify,
hold harmless, and defend, to the fullest extent of the law, each signatory to this
Agreement, whose only involvement in the transaction or occurrence which is the
subject of such claim, action, demand, or other proceeding, is the execution and
approval of this Agreement.
D. LITIGATION PROCEDURES. Parties' personnel shall cooperate and participate
in legal proceedings if so requested by another Party and/or required by a court of
competent jurisdiction.
E. TORT CLAIMS ACT. No provision of this Agreement shall remove from any
Party any protection provided by any applicable Tort Claims Act.
F . WAIVER OF RIGHTS. Any waiver at any time by any Party of its rights with
respect to a default under this Agreement, or with respect to any other matter
arising in connection with this Agreement, shall not constitute or be deemed a
waiver with respect to any subsequent default or other matter arising in
connection with this Agreement. Any delay in asserting or enforcing any right,
except those related to the statutes of limitations, shall not constitute or be deemed
a walver.
3. DISPUTE RESOLUTION. If a dispute between the parties to this Agreement arises out
of or related to this Agreement, or the breach thereof, and if the dispute cannot be settled
through direct discussions, the Parties in dispute agree to first endeavor to settle the
dispute in an amicable manner by mediation. Thereafter, any unresolved controversy or
claim arising out of or related to this Agreement, or breach thereof, may be settled in a
court having jurisdiction thereof. The Parties may seek to resolve disputes pursuant to
mediation or arbitration, but are not required to do so.
ARTICLE XIII
LICENSES AND PERMITS
When invoking Assistance, the Requesting Party shall define as precisely as possible the
licensure requirements of personnel being requested from the Assisting Party. The Assisting
Party agrees to exercise reasonable diligence in verifying personnel's licensure and in responding
to the specific licensure requirements requested by the Requesting Party. A form located in
Annex B, signed and authenticated by the Human Resource Manager of each Assisting Party will
be presented at Incident Check-In, by all employees to certify their credentials.
ARTICLE XIV
RECORD KEEPING
Time sheets and/or daily logs showing hours worked and equipment and materials used or
provided by the Assisting Party will be recorded on a shift by shift basis by the Requesting Party
and/or the loaned employee(s) and will be provided to the Assisting Party as needed.
Additionally, the Assisting Party will provide shipping records for materials, supplies, equipment
and/or related resources, and the Requesting Party is responsible for any required documentation
of use of materials, supplies, equipment, facilities, services, and/or related resources for state or
federal reimbursement. Under all circumstances, the Requesting Party remains responsible for
ensuring that the amount and quality of all documentation, uses appropriate ICS forms found in
Annex A and is adequate to enable state or federal reimbursement but responding employees
should keep a time log, using appropriate res forms, during their deployment and review this
information with the Requesting Party prior to departure.
ARTICLE XV
OTHER OR PRIOR AGREEMENTS
This Agreement is not intended to be exclusive among the Parties. Any Party may enter into
separate agreements with any other entity. No such separate agreement shall terminate any
responsibility under this Agreement.
ARTICLE XVI
EFFECT OF DECLARATION OF EMERGENCY
The Parties recognize that state or federal declarations of emergency, or orders related thereto ,
may supersede the arrangements made or actions taken for rendering Assistance pursuant to this
Agreement.
ARTICLE XVII
MODIFICATION/TERMINATION OF AGREEMENT
No provision of this Agreement may be modified, altered or rescinded by any individual Party
without the unanimous concurrence of the other Parties. Modifications to this Agreement must
be in writing and will become effective upon the approval of the modification by Parties.
Modifications must be signed by each Party.
A Party opting to terminate this Agreement shall provide written termination notification to the
Authorized Representatives of all Party. Notice of termination becomes effective upon receipt by
all Authorized Representatives. Any terminating Party shall remain liable for all obligations
incurred during its Period of Assistance until the obligation is satisfied.
ARTICLE XVIII
ENTIRE AGREEMENT
This Agreement constitutes the entire agreement amongst the Parties .
ARTICLE XIX
SUCCESSORS AND ASSIGNS
This Agreement is neither transferable nor assignable, in whole or in part, and any Party may
terminate its participation in the Agreement pursuant to Article XVII.
ARTICLE XX
GOVERNING LAW
This Agreement shall be interpreted, construed and enforced in accordance with the laws of the
State of Washington.
ARTICLE XXI
INVALID PROVISION
The provisions of this Agreement are severable. If any portion of this Agreement is determined
by a court to be void, unconstitutional or otherwise unenforceable, the remainder of this
Agreement will remain in full force and effect.
ARTICLE XXII
NOTICES
Except as otherwise provided herein, any notice, demand, information, report, or item otherwise
required, authorized or provided for in this Agreement shall be given in writing and shall be
deemed properly given if (i) delivered personally, (ii) transmitted and received by telephone
facsimile device and confinned by telephone, (iii) sent by United States Mail, postage prepaid, to
the Authorized Representatives of all affected Parties at the address designated by such
Authorized Representative, or (iv) sent by email with electronic signature ofthe Parties
Authorized Representative.
ARTICLE XXIII
NO DEDICATION OF FACILITIES
No undertaking by one Party to the other Party under any provision ofthis Agreement shall
constitute a dedication of the facilities or assets of such Party, or any portion thereof, to the
public or to the other Party. Nothing in this Agreement shall be construed to give a Party any
right of ownership, possession, use or control of the facilities or assets ofthe other Party.
ARTICLE XXIV
NO PARTNERSHIP
This Agreement shall not be interpreted or construed to create an association, joint venture or
partnership among the Parties or to impose any partnership obligation or liability upon any Party.
Further, no Party shall have any undertaking for or on behalf of, or to act as or be an agent or
representative of, or to otherwise bind any other Parties.
This Agreement may be executed in two or more counterparts, each of which shall be deemed an
original, but all of which together shall constitute one and the same instrument. For p urp oses
hereof, a facsimile copy of this Agreement, including the signature pages hereto, shall be deemed
to be an original.
IN WITNESS WHEREOF, this Agreement has been executed and approved and is effective and
operative as to each of the Parties as herein provided.
SIGNATORS PAGE FOR REGION 7
HEAL THCARE MUTUAL AID AGREEMENT
SIGNATORS l'AGt<:
i"OR
REGION 7 IIRALHICARK
MUTUAL AID AGREElm:r.~'
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MUTUAL All) AGREEl\n~NT
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Chelan County Coroner
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Oouslas County Coroner/Prosecutor
Name ________________________ ~ Date, __ _
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Name . . J . J 0 '1 t= J 7 ·' D~;!.V / It 7 (loll
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Name ____________________ _ Date ___ _
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SIGNA TURI~S .'OR
REGION 7lfEALTIICARE COAUTION
MUTUAL AID AGREEMENT
Kittitas County Emersency Management
Name ________________________ __ Date __ _
Signature _______________________________ ~
Kittitas County Coroner/Prosecutor
Name _______________________ _ Oate __ _
Signature ____________________________ _
Okan08an Sheriffs OffIce -Department of Emergenc:y Management
Name ______ ~ ____________ _ Oate __ _
Signature _____________________________ _
Okanogan County Coronet/Prosecutor
Name _____________________ _ Oate ___ _
Signature ___________________________ _
Funeral Home Directors/Association
Filcility Name: ________________ ~ County _________ _
Namc _________________ ___ O<tto ______ _
Slgnature _____________________________ _
Facility Name: _____________________ _ County ______ _
Name __________________ ___ Date _____ _
Signature ________________________________ _
SlGNA11IRES
REGION 7 HEALTHCARE COAl./TlON
MUTUAL AID AGREEMENT
1 __ the ~ton 7 Mutuol Aid AgrHm .. t and apm with the prtndpaJs m/DrtlI
within th~ document.
Chlef_OftIttIl.l.~sn"'I! '\.
SIan_lUr.: L ~ ~ V
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TIde: Co~)..Ji?~
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AaentY Emerp_ ""P8"-' and R .......... CaoI'dlnootor:
s.snaturr.
Prlntllam.: ___________________ ~ __________ __
TltIe : ____________________________ _
Date :
Sl6NA11IRES
REGION 7 HEALTHCARE COAUTlON
MUTUAL AID AGREEMENT
,_ -the R~/on 7 MutJJOllIId Ag __ nt and Ofl-wHh tho pr/ncIpol! setfwth
within rhedoaJmmt.
Pl1nt Name : N C! B n
Sllr1i11ture: SM' Ai AIoyJ .
PrInt Nome: ____________________________ _
---------
Date:
SIGNATURES
REGION 7 HEAL THCARE COALITION
MUTUAL AID AGREEMENT
1 have ~ad the R~ton 7 Mutvalllld Ag~m~nt and ag~ with the principal! ~t forth
within t¥ docvnw:/ft.
Apn<y Nome, Obnosan County Departmont of Emergency Mln_gemenl
Chief becutlve ~ delli neel:
Signature: ,1i.;'4
7 '
Print HIlmO: Mourlc"Good.1I
TItle: Emltrflency M.n ....... nt DlrO<tor
O.te: 10/19/2016
~e: __ ~~~~~~~~~L-----------------__
Date :
~pt~mb«, 2015
SlGlfAl1JIIB
REGION 7 HEAl.THCAII£ COAUTION
IlUTUAi. AIJ) AGIIKMfNT
,_ "",d"'" Region 7 Mutual AId Ag,..,.,.,nt IIItd ag,.. WIth the prlndpals sot forth
wlthlnthe_.
Sf..,.cure:
pnmNUM:~~~~~~~ ______________ ___
TItle: 11d ,Yl{J1A \ t"lliD V
Oil.: 11 II I "
SlGNAnJRES
REGION 7 HEALntCARE COAlJTlON
MI1TUAI. AID AGREEMENT
I '""'" rood the Region 7 Mutual Aid A,ree_nl and a',.. with the prIncipals set forth
withIn til. d __ nt.
Chief E~ OffIcer (or de'IA"".):
Signature:
bri D N
D.t.: ~ ..... ____ _
Aaencv Eme ... ncy Preparedness and Response Coordinator:
Signature: \
PnmN.me:~~~~~~~'_ _______________ ___
Title: !\i'tS'r cirq;er,...eAI'"('( llltyV ,... t'ru'*I,,J &. ~rl!:i •
Date :
·,fl~pm~f.1:)J"
SlGNAnJRES
REGIOfI1l1EA1.THCARE COAUTION
MUtUAl. AID AGREEMENT
l_mxJthe/kfl/Olr7MutudAld~tlJlldl1Jl __ theprlttdpaJsNf/ortll _""'_t
....,_'~""'ntyPubIcHt ollh'-_______ _
ChIef ExecutIve om-(or dtsl ...... ):
SIptww: (;-t:w' ~M<"
MmN~:~rl~~ _____________ _
lItIe: CommunllyHloith Oi'octo<, _____________ _
Date: 11/l5/20l6 _________ ~
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PrlmNamo: ..... ,,_, _______________ _
TItle: CommunltyH_ ""oc;to, ____________ _
Date: 11/15(.1016'-_______ _
~Pf~mHr. 1OJ6
SIGNATURES
R£GION 7 HEALlItCARE COAUl1ON
MUTUAl. AID AGREEMENT
I have read the Region 7 Mutual Aid A_ment and agree _ ttle principals .otforth
wtrhIn rfle doaIment.
Afon<Y -, a. ..... CDunty Coroner
a...., ExecutIve OfIIcer (or des/anee):
S/snabIre:
I:'rtnt Name: WII'{ne E. Harrls
TItle: Coroner
Oate: October 5, 2016
Apnqr Eme,..ncv Preparedness and __ CGordlllltor:
Sf",""re: W <:W..L. G". J4-..,4
Pnnt Name: Wayne E. Harris
'nile: Coroner
SlGN"TURES
REGION 7 HEAllltCME COAUllOH
MUTUIU. IUD "GREEMENT
1 have mxI rtte RIfj/on 7 MullJD/ AId Agreement and IlfIr« with rtte princ/p<I/s ~t forth
Within the document.
TlUe: _ ..... C-<;C ..... O"'-' _____________ _
DOle: f41l-ll lalt
Asenev ErnertIenev Preparedness and Respon .. Coordinator:
SI_ture: ~~~""'-___________ _
Prlnl Nome: 1)0.0& Weller
nth!:~ ____ _
Dille: 011 Oct I\,
SIGNATURES
REGION 7 HEAlTHCARE COAUOON
MUTUAl IUD AGREEMENT
,_ read rtte Reglan 7 Mllfuol Aid Agreement and agree with the prtnclpal< set forth
within tire document.
Chi., Executive Offlcef (0' deslsnee):
TIlle : ~s".i ' I /Iff; \ 'fjl1Q k'1fIHl) r~~fl1nXJ:b~\m.ok
Dot.: ~!i.Illr.L. ____ _
Srptrmber,1 0J6
SIGNATURES
REGION 7 HEAlTHCARE COA1l1lOH
MUTUIU. IUD AAO IlE£MtNT
,_ mxI the RIfj/on 7 Mutual AId Ag~e_nt and ag __ /fl. prlnc(pal< set forth
within me document.
Chief Executive OffIcer (or dosisnee):
Sisnatu,e: 87£(4; d'l<'/.f.e7?<
PrInt "am.: ~/?d C!HIt..S ()N
ntle: &0
Oat.: /0-~5" / (,
Asency Eme'lency Prepanedness and Respon .. Coordlmotor:
Stanalure:
Print NII'I!':
nth!: ______________________________________ __
Dill.: __________________ _
~pt~'"~r.1OJ6
SIGNATURES
REGION 7 HEAllltCME COAlITION
MUTUAl IUD AGREEMENT
I have reGd tire Reglan 7 Mutual Aid Agree_nt and agree with the principals ~t forth
Wllh", Ihedocvtr!Mt.
AIMKY~: ____ r,~.r~.~nt~~~"t~y~~~a~I ~~~D l~s~trDl£ctL_ ____________ __
Chief Executive OfIker (or designee):
5lsnllture: J" I ~ A " k ' 0: t J '
PrInt Nom.: ____ Tb.!..!!!!!tli:llil:S"'lIwd!<_In!l:! .... m.. ______________ _
ntle: _____ .!.AdmO!OJJ"'In!!!II!!!lfI.!!l"'OIL-____________________ _
Dlte: ~""btt 28. 2016
Asency E_'Ieney "IrtIlSI and Rnpon .. Coordinator:
Sl&nature : ~ /-l &h -e I
~tH.m.: ____ -nlpn~H~H~S~ ____________________________ __
ntle: _--J!.oQJ_' I!.5!EiY1:!!'ll'/JIlOl!!n!!&cvIt/R9"W!!AAI!!" !!!SOWC.!!OCj!!I1!r!!!!lI!lllIIl!QfL ________________ _
SlGNATUIt£5
REGION 1 HEAl.1HCARE COAU11ON
MUTUAL AID AGREEMENT
I haW! rrod the Region 7 Mutual Aid Agrement and ogIN with rho principals set forth
within rhe document.
Totle : __ ----'C@J~-------------tll l'b /~\(; Dote:
........., Emergency Preparedness and Response c--dInat«:
SJanature:
Print Name: Al,~d..A.c.l
TIIIe:~~-""",,,, __________ _
Oat.: ,eM (P
Sepremb .. "2016
SlGNAlUUS
REGION 1 HEAl.11tCARE COAl.ll1ON
MUTUAL AID AGII&'MINT
I ha .. rrod ~ Region 7 Mutuol AId At/tH-tIIId og __ tho ptlnclpols K'forIh _rn rho doc _.t.
Chief executive 0IIIcer lor desi8nee):
-, ,I'.\~
Print Nomo: ---..J J;.!l
TId.: C(o
Dot.: _!:'#I:..-..:5...,;-lfl=''''"------
Prln.N ..... : J!i.Q1,;,).Ju:::L_lA.¥i.!:.~ ________ _
lltle: -@4;.,\"aQnf'C= nt<cnc"s-r
Ooto: .J.a::;~~.;"~t...IJ'I/..~---I i
SIGNATURES
REGION 1 HEAL ""CARE COAU11ON
MUTUAL AID AGREEMENT
I haW! rrod the Regl." 7 Mut.ol AId Ag .... m.nr ond og_ with the principals ut forth
wlthln.lM docIIf!'C1I "
Chlof ExeaJtive Offl_lor desiBnee):
S1111ltu,e:
Print Name : _?::><=--_d----'21~_Dc./U.L. ___ ~ __________ _
lItle: ---.:C~Q:.::O~/:....::C..::D':.::O:::.-___________ _
Date: ~1:.:o~/..:-~~/:..:I:..:I.D=--__ _
Alencv Emerpncy Pre ..... ed ..... and Response Coordinator:
Signature:
pnntNom.: ___________________ _
lIt~: _________________ __
~.: ---------
5epl~mber, 10J6
SIGNATURES
REGION 7 IllALTHCARE coAU11ON
MUTUAL AID AGREEMENT
I hall. rNd tho R.glon 7 MlffUol AId Ag .......... ond ag,.. with the principals .. r forth
wllhln .he document.
Chief ea-tlve~KCtl~,""I :'
Sllnlfur.: ~
PrintN.me: 1)1 \lI{~ _O \~l----
ntl.: __ -1t~E-~O~------------
Date: __ .!.J'I/J~oLI.:../"=----
Alency Emttrlencv PNpllredness ;mel Response Coordinator:
Si .... wr.:
PrintName: _________________________ _
TItle: ___________________ _
Dot.: ____________ _
SIGNAlURES
REGION 7 HEALTHCARE COAUTION
MUTUAl AlD AGlI£fMEl'f1'
I how read the Rlg/on 7 Mutual Aid Agreement and aglfle with thl prlndpals .. tforth
w/tltln th,," d~v,""nt
ChlefExecutJve ~snee):
Sl..,ature: ~ ~A ::;:::0..
Mnt Nam.: lull!! Potr qon
nde:~a~QL-____________________________________ _
Dote: __ 'lL.L:;!.:l"-''1w / ..... , ...... I...--_
Alencv f?:: P;:/fn:ss and Respon .. COo~~r.
~Itu~~~~.~~~~~~---------------------
pnntN.m.:j~~~Iill~m~ ________________________________ __
TltIe: DlrtQ!Jf cardtppulmonnry Set)r1eI & Q!astt (q9td1n Or
Date: 4i~/'
SIGNATURES
REGION 7 HEALTHCARE COAUTlON
MUTUAL AID AGREEMENT
I hDve read the Region 7 Mutual Aid Agreement and ogree with the principals set forth
...Ithln'h.d .... ",...t.
:.:::~:??-~~-j
Prlnt Na~.: :. ;; =~ f)~C; /
lltJ.: ( _E()
Oato: q -19 -2 0l(P
septtm/)er, 20J6
SlGNAlURES
REGION 7 HEAL THCARE COAUTION
MUlUAi. AID AGREEMENT
I hove read the Reglan 7 Muwol Aid Agn.ment ond agre. with the principals set forth
within the document.
o,ief Exeartlve OffIce, (or deslsnee):
Signature : t .... ~j
Print Nime: K.,; • AI .I
Title: { to
Dlte: I~ J . L~tt'
Alency Eme,..ncy "e"",edn ... and Response Coo~rqto,:
Sianature:
PrlntNlme: ______________________________________ _
nt~: ______________________________________ _
Olte: _________________ _
SIGNATURES
REGION 7 HEALTHCARE COAtmON
MUruAl AlD AGREE _1fT
/ ""oe .. od the RegIon 7 Mutual Aid Agreement and og,... with the pr/ndpo/s .. t forth
within the docum."t
o,ief ExIKUtive Offlao, lO1"oI~~'IIl'~:
SlBnature : IZ-"" t!J4 8WA !k
Print N.m.: __ ~!.J ~!;t ... ~-IoOLI!,; d-.~LII!..qlfL!.r.J!fI!.. .. "_ _____________ _
Til~: ___ .:!:."r:;.kJ...:..J' {<-tJAL-_________ _
I
Date: ,oU3-"
Aioncy EmerpnCV P_, ........ anclRespon .. c-nIInatar:
SlcnatUfe:: ~\)S
Prlnl Namo : OK"" --kw \>s
ntl.: ~~~",.:t..:.4!4,-'O~'~~:l.v...-=.:.---------
Dlt.: __ ,.!.I"'o-.;7'-1..t, ... ·_---',;..c...>-__ _
SlGNAT1JIIfS
REGION 7 HEALlIICARE COAU11ON
MUlUAL AIDAGREEMIm
,_ rrad the Region 7 MUIwI Aid A9I __ m rmd .glft with tho prlncfpo/s m forth
within tM docutMnt
Aloncy Nam.: --"C==,,'-"""c."'cui="_Il1---"-"Je..''''r.:;:Q.'''I ________ _
Chief howtllle. 0ffI .. , lor .d .... "MIl ):
Stenatur.: I ( -G 1& (
Print Name: 'h i" '\-< 1\\" It ......
Tltl.: _-'C!""I?=.C"'-_________________ _
Date : It c:, I Lr
pnnINam.: __ ~t_~~~-----------------------------
TItI.: -"==='-'===-f=:.:..:.>=if=4-....r.:.::,:;==::!o> ........ =""-"
Date: I(}-r -/~
SIGNATURES
REGION 7 HEALTHCARE COAlITION
MUTUAL AID AGREEMENT
I h.ve r •• d tho Region 7 Mutu.1 Aid Agreement .nd agree with the prlnclpols set forth
within the document
AgencyNam.: __ ....:G~O~N~~~'..!SM~i:4~-~H.~'6tI==IJ7J:...!..!----
Chief Executive OffIcer (or de,'snee):
Slinalur.: ~t-
Print Nam.: ,,~ Q.l1~ ,4>'
Date: 0 <1 \. ... '1 \ 2.01'"
Date: Orz:?/?
SIGNATURES
REGION 7 HEALlliCARE COAlITION
MUTU AL 1110 AGRflMlHT
I ho.,. red tM Region 7 Mutual Aid Agre.lMI1t and Qg~~ witt! t"~ principals s~t/orth
wftl1ln tM document.
Thl.: Act'-tv!l(,frmtr
Dat.: u,hf(!tr..
Alancy Emorpncy p,.pared ...... and Response Coordinator:
Signature: L'a..~W.y.b ... ..e.e='
'''n,Nam.: WMtJ.; W :1tC t-r;/li i
Thl.: i24t1I ~ 5J..petVlvrc
01'.: 4l'r."t~~I(:.pf----
SIGNATURES
REGION 7 HEAL ""CAllE COAUT1ON
MUTUAL AID AGREEMENT
I h.ve read the Regk>n 7 Mutu.1 Aid AgIoement .nd .gree with the prlnclpols set forth
within tho document.
"'._"'_I.~
Sianatur.: ~
Print Name : ( ,J;i~_-,{)c.o..4'",of",-".....;=..:!C ....
Thl.: ----------"7~_I.;pfC-.. :O'""'-------------------------
Date : q/Jij;Ou.,
Agency Emergency Prepanedness and R .. ponse coordinator:
SIgnature: ---;::?~6h
'rlnt Name: "B"'I O'!
Thle : D."J.-.3?\<or,\ Op_L, .... :-
Date: 9/ zal ZQllp
S('plembt'f ,lU1 6
loday's Date
10/25/2016
Fund/Department
116-Public Health
Kittitas County
Review Form
Grants & Contract Agreement
I Agenda Date
Cont r act /Grant Information
Contract /Grant Agency: Region 7 Healthcare Mutual Aid Agreement
\2 \ Lv \ \ U
Period Begin Date: Upon execution Period End Date: Upon termination in writing
by either party
Total Grant/Contract Amount: $0
Grant/Contract Number:
Contract/Grant Summary:
The Region 7 Healthcare Inter-Jurisdictional Mutual Aid Agreement is made and entered into by the
signatory Healthcare Agencies within Region 7 in the State of Washington. Each party desires to
voluntarily aid and assist each other by the interchange of healthcare resources and services in the event
that a Public Health Incident, Emergency or Disaster situation should occur-; The party finds it necessary
to execute this agreement for the interchange of such mutual assistance on a county and/or regional
basis.
Recommendation for Board of Health and Board of Health Review on
Department Head Si gna ~4.,ttt ' AEim inistrator Date : 1:L ,f q (IC,
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APP R ~VED AS TO FOR M : 1.JI I'd-'
U/ .
';.b-, • d11 . ,4J, ~ .
Signature of Prosecutor' r6 Date
l.
Date
Signature of Board of Health member Date
Financial Information
Grant/Contract Review Page 1
Total Amount $ State Funds $ Federal Funds $
Percentage County Funds Matching Funds $ CFDA#
In-Kind $
Explain
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring -reporting requirements
Future impacts or liability to Kittitas County :
Budget Information
Budget Amendment Needed? Yes 0 attach budget form No 0 Why not
New Division Created?
Revenue Code
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date :
Prosecutor Review
I Has the Prosecutor reviewed this agreement? I Yes 0 No D
Coun t y Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
I Signature :
Department:
I Date:
Assignment of Trackin g Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
I Reviewer I Date
Grant/Contract Review Page 2
Grant/Contract Review Page 3