2014 Volunteer Fire Department Fund

AGREEMENT OF PAYMENT FORM

[Name of Department, [______]County

We, the undersigned, attest that we are appropriately authorized to speak on behalf of and bind the [Name of Department], hereby referred to as Grant Recipient, for the purposes of participation in the Volunteer Fire Department Fund Grant Program and agree to the following as conditions of participation in the Program:

1. No equipment ordered prior to May 15, 2014 will be honored for payment with grant funds. All equipment must be received and all required forms and invoices/bills must be submitted to the Department of Insurance postmarked no later than September 30, 2014 or Grant Recipient will forfeit its 2014 Volunteer Fire Department Fund matching funds. No backordered equipment after the September 30, 2014 deadline will be honored.

2. Grant Recipient possesses the required amount of matching funds to participate in the Volunteer Fire Department Fund Grant Program. Should circumstances change and Grant Recipient not have the required matching funds available, the Volunteer Fire Department Fund Grant Program will not extend associated deadline dates and proposed award monies will remain in the fund.

3. Grant Recipient understands that the Volunteer Fire Department Fund will release the matching funds to Grant Recipient upon receipt of all required information. Payment will not be made directly to any vendors. Payment options and arrangements are to be made entirely between the Grant Recipient and its vendors.

4. Grant Recipient agrees that equipment may be placed into service at the time of delivery, but MUST be available for inspection upon delivery of Grant funds or inspections. All approved equipment must be maintained by Grant Recipient for a period of five (5) years from the date of the grant award and is subject to inspection/audit.

5. Grant Recipient agrees that if equipment purchased with Volunteer Fire Department Fund grant monies is disposed of within five years of the date of the award of the grant funding its purchase, then Grant Recipient must reimburse the Volunteer Fire Department Fund the amount of grant monies used for the purchase of the equipment, less depreciation, as determined to be appropriate by the Department of Insurance.

6. Grant Recipient agrees that, if it ceases to exist within five years of the date of award of the grant, it must transfer any and all equipment purchased with grant funds to whichever fire department assumes responsibility for providing service to Grant Recipient’s area of service, as determined by the Department in consultation with the appropriate county authority, prior to dissolution of the Grant Recipient.

SIGNATURES OF CHIEF AND EITHER BOARD PRESIDENT (FOR INCORPORATED DEPARTMENTS) OR MAYOR/TOWN MANAGER (FOR MUNICIPALITIES) ARE REQUIRED.

______Date: ______Signature of Chief

AND ______Date: ______Signature of Fire Department President of Board of Directors (Incorporated Departments)

OR ______Date: ______Signature of Mayor/Town Manager (Department owned by Municipality)