DES EMERGENCY REPATRIATION SOP MOU.PDF
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ARIZONA DEPARTMENT OF ECONOMIC SECURITY Emergency Planning & Preparation Administration • Office of Inspector General MEMORANDUM OF UNDERSTANDING REGARDING PARTNER RESPONSIBILITIES AND OBLIGATIONS We Thank You For Your Service! I, the State of Arizona (State) Emergency Repatriation Plan (SERP) partner named below, have read the current Arizona State Emergency Repatriation High Level Operational Plan Standard Operating Procedures (SOP), dated __________________. I understand that the SOP describes my roles and responsibilities as a SERP partner, is incorporated herein by reference, and I agree to perform the responsibilities assigned to me in the SOP. 1. Nature of Service I understand that my service as a SERP partner requires my performance of the responsibilities outlined in the SOP and agree to perform those services in accordance therewith. I understand that the SOP will be updated periodically (at times in consultation with me), and agree to stay abreast of all such responsibilities assigned. If I plan to seek reimbursement for the goods or services I provide while performing the assigned responsibilities, I agree to track my costs as they accrue in accordance with generally accepted accounting principles, and to provide needed documentation related to my request for reimbursement. 2. Confidentiality I understand that in the performance of my duties, I might have access to repatriates’ personal and financial information. I agree that I will use such information only to the extent necessary to perform my responsibilities outlined in the most current SOP. I also agree to comply with all applicable local, state, and federal confidentiality laws when handling confidential information, including HIPAA when applicable. 3. Term of Service I understand that this Memorandum of Understanding will expire three (3) years from the last date of signature below and agree to perform my responsibilities as outlined herein or as incorporated by reference until such time. 4. Authority to Execute Each of the individuals whose signature appears below represents and warrants that he or she has full authority to execute this Memorandum of Understanding on behalf of the party on whose behalf he or she has affixed his or her signature to this Memorandum of Understanding. ___________________________________________________________________ __________________ Printed Name and Signature of SERP Partner’s Authorized Representative Date ___________________________________________________________________ __________________ Printed Name and Signature of EPPA Representative Date Maricopa County Department of Emergency Management______________________________________________ SERP Partner’s Name/Entity (please print legibly) __________________________________________ ____________________________________ Street Address Email Address ___________________________________________________________________ __________________ City State Zip Code Telephone # __Maricopa County Department of Public Health_________________________ SERP Partner’s Name/Entity (please print legibly) __________________________________________ ____________________________________ Street Address Email Address ___________________________________________________________________ __________________ City State Zip Code Telephone # Memorandum of Understanding between Maricopa County Department of Emergency Management and Public Health with Arizona Department of Economic Security MARICOPA COUNTY BOARD OF SUPERVISORS BY: _________________________________ Chairman, Board of Supervisors Date: ______________________ ATTEST: ________________________________ Clerk of the Board Date: ______________________ Approved as to form: ________________________________ Deputy County Attorney Date: ______________________