Ohio Emergency Management Agency
EMAC Deployment Information Sheet
General considerations and information for offering resources to requesting states:
· EMAC is a mutual aid agreement between member states that provides for reimbursement, liability protection, and license reciprocity.
· State/local jurisdictions must first pay for all eligible expenses related to deployment in order to be reimbursed by state of Ohio or Requesting State
· The following information is required to provide a requesting state a bid to determine the need of Ohio resources. If Ohio is chosen as an assisting state, this information is required to execute an agreement between the political subdivision and the Ohio Emergency Management Agency
· Personnel/Equipment deploying to field are requested to be ready to work upon arrival. Supplies, tools, and personal protective equipment appropriate for function should be taken to field
· Information on this sheet should be helpful in preparing documents for the reimbursement process; please request any personnel deploying to keep accurate documentation and receipts for items such as time worked, items purchased and equipment used
· A Req-A Attachment documenting your deployed personnel’s names and contact information while on deployment must be completed prior to deployment. This document will be provided by Ohio EMA or ESF coordinating deployment.
· Be sure persons deploying to field have Ohio EMA’s “EMAC Mobilization Checklist” prior to deployment
· DO NOT DEPLOY UNTIL AUTHORIZATION IS GIVEN BY OHIO EMA AND A FULLY EXECUTED INTERGOVERNMENTAL AGREEMENT IS SIGNED BY BOTH YOUR JURISDICTION AND OHIO EMA
Fax Completed Form to: ______at: ______
Type of Resource:EMAC Request Number and/or Mission Number, if known:
Personnel or Resource with Labor Cost:
(Persons available to meet this specific EMAC Request; include name/rank or appropriate information)
For Labor Cost:
show hourly wage rates for regular time and overtime, including all fringe benefits included
For purposes of estimating only, calculate based on working a 12 hour day / Name of Personnel or Resource with Rank / Deployed cell phone number / Regular Hourly Wage including all fringe benefits / Overtime Wage, including all fringe benefits / Total per person per day:
12 hr. day
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Jurisdiction
Agency
Address
Person completing this form
(Contact Person) / Please include: Name and Title
Phone Number (Contact Person) / Cell Phone Number:
(Contact Person)
Fax
(Contact Person) / E-mail
(Contact Person)
Person Authorized to Sign Agreement / Please include: Name and Title
This person should be a County Commissioner, Township Trustee or Mayor – Authorization legislation must be provided with intergovernmental agreement if a person other than listed signs document
Phone Number (Authorized Signature) / Cell Phone Number
(Authorized Signature)
Fax Number (Authorized Signature) / E-mail Address
(Authorized Signature)
Departure Date of Resource: / Return Date of Resource:
Duration (Duration of deployment, including travel days)
Travel Cost:
(Mileage per vehicle, estimated fuel cost per vehicle, cost of vehicle per hour) PLEASE LIST COSTS SEPARATELY; IF PER DIEM TOTAL APPLIES, PLEASE INDICATE / Example: 980 miles (one way) X. $0.325 = Total Amount of vehicle travel
(Please show per vehicle)
Total Cost TO Staging Area: / Total Cost FROM Staging Area:
Food Cost:
(Estimated actual costs or per diem rate per person per day, based on existing state or local travel policy) / Ensure Meal costs are compliant with state or local jurisdiction travel policy
Lodging Cost:
(Estimated actual costs or per diem rate per room, per night, based on existing state or local travel policy) / Ensure Lodging costs are compliant with state or local jurisdiction travel policy
Response Related Equipment Cost
(This includes equipment used for the mission upon arrival. Please utilize existing equipment use rate policies or the current FEMA Schedule to estimate actual costs - provide an estimated per hour or per day cost)
Response Related Supplies Cost
(This includes supplies necessary to accomplish the mission upon arrival & supplies purchased prior to deployment for any self-sustaining mission. This does NOT include deploying personnel personal items)
Total Estimated Cost of Deployment
EMAC Deployment Information Sheet Current as of 7/20/2010
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