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Cole County Emergency Response Team Missouri Mobile Emergency Operations Center (MEOC) Non-Emergency Deployment Request

  1. Requester Information:
  2. Agency making request
  3. Who should we contact if needed?
  4. Contact phone number
  5. Please check all items that your agency acknowledges or agrees to provide during the MEOC deployment:
    If selecting checkboxes for ICS-205 Incident Radio Communications Plan or MEOC Frequency Authorization Form click on applicable form to download to your computer. Fill out, save, and upload completed documents when submitting this form.
  6. Check applicable
  7. Check if applicable
    *See forms below
  8. Check if applicable
  9. check
  10. How many lines via satellite are needed? Rate of $50/mo.
  11. Check applicable
  12. check
  13. Circuit Types:
  14. Equipment Use Agreement
  15. This is an agreement between the Cole County/Jefferson City Emergency Management Agency (lender) and (borrower)
  16. Borrower's name here

  17. for use of equipment -
  18. Equipment kind/type

  19. from/to (date) -
  20. Start date

  21. Equipment Use

    Under the normal exchange of equipment both parties agree that the individual assigned to operate the equipment must be trained on the operation of and recognizes the hazards of the equipment. Borrower will have a certificate of insurance and adequate insurance to cover damages. 

    The borrowing agency shall indemnify and hold harmless Cole County to the fullest extent permitted by the laws of the State of Missouri in effect at the time against and in respect of any and all actions, suits, proceedings, claims, demands, judgments, costs, expenses (including advancement of reasonable attorney’s fees), losses, and damages resulting from Burrowers good faith performance of duties and obligations with the Cole County. 

    The borrowed equipment must be returned to the owner in the condition it was received. The borrower is responsible for all reasonable repairs including parts and labor should malfunction or damage occur during the borrowing period. Inspection of equipment is encouraged before taking possession. Equipment use authorization form must be completed and signed before taking possession of the equipment.

    Borrowing party is responsible for all liability, losses, damages, costs or expenses which arise out of the negligent act or omission of the equipment user while acting in the course of their involvement with the above mentioned agreement.

     For normal exchange of vehicles or equipment, a minimum of seven working days’ notice must be given to the lender prior to expected date of use. All completed and authorized documents must be received by the lender two days prior to the expected date of use. Equipment use is for a 24 hour period. Extensions may be granted by appropriate personnel.

     In the event of an emergency in which there is an identified need for the retrieval of equipment to respond to such an emergency, property will be retrieved by lender at little to no notice.    

    Please sign the Electronic Signature Agreement below if you agree with these terms  

  22. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  23. Upload completed ICS-205 Incident Radio Communications Plan and/or MEOC Frequency Authorization Forms
  24. Leave This Blank:

  25. This field is not part of the form submission.