"Cost Share Agreement Template"

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C
S
A
T
OST
HARE
GREEMENT
EMPLATE
COST SHARE AGREEMENT
Between the
XX AGENCY
And the
XX AGENCY
This   c ost   s hare   a greement   i s   b etween   t he   a gencies   i dentified   a bove,   a s   n egotiated   f or   t he   f ollowing   i ncident   i n   a ccordance   w ith  
the   S tatewide   C ooperative   F ire   P rotection   A greement   # xx-­‐xx   e xecuted   b etween   t he   p arties   o n   ( date).     T he   p urpose   o f   t his  
agreement   i s   t o   a llocate   f inancial   r esponsibility   a s   o utlined   i n   t he   X XX   F ire   D ecision   D ocument   a nd   t o   d escribe   t he   c ost   d ivision.  
General Incident Information:
Incident Name:
Incident Start Date and Time:
Origin:
Township:
Range:
Section:
Estimated Size:
Acres at the time of this agreement:
Incident Cause:
Incident Numbers by Protection Agency:
Agency
Incident #
Accounting Code
Cost Share Period: This agreement becomes effective on the date indicated below and will remain in effect until
amended or terminated.
State date/time:
End date/time:
Other conditions relative to this agreement:
1.
Costs incurred by cooperators not engaged with the host agency or IMT in the fire suppression activities will
not be included as a part of this cost share agreement.
C
S
A
T
OST
HARE
GREEMENT
EMPLATE
COST SHARE AGREEMENT
Between the
XX AGENCY
And the
XX AGENCY
This   c ost   s hare   a greement   i s   b etween   t he   a gencies   i dentified   a bove,   a s   n egotiated   f or   t he   f ollowing   i ncident   i n   a ccordance   w ith  
the   S tatewide   C ooperative   F ire   P rotection   A greement   # xx-­‐xx   e xecuted   b etween   t he   p arties   o n   ( date).     T he   p urpose   o f   t his  
agreement   i s   t o   a llocate   f inancial   r esponsibility   a s   o utlined   i n   t he   X XX   F ire   D ecision   D ocument   a nd   t o   d escribe   t he   c ost   d ivision.  
General Incident Information:
Incident Name:
Incident Start Date and Time:
Origin:
Township:
Range:
Section:
Estimated Size:
Acres at the time of this agreement:
Incident Cause:
Incident Numbers by Protection Agency:
Agency
Incident #
Accounting Code
Cost Share Period: This agreement becomes effective on the date indicated below and will remain in effect until
amended or terminated.
State date/time:
End date/time:
Other conditions relative to this agreement:
1.
Costs incurred by cooperators not engaged with the host agency or IMT in the fire suppression activities will
not be included as a part of this cost share agreement.
2.
Responsibility for tort claim costs will not be a part of this agreement. Responsibility for these costs will be
determined outside this agreement.
3.
Costs for accountable, sensitive, and durable property purchased by each agency will be charged directly to
that agency and will not be shared.
4.
Non-suppression rehabilitation costs are the responsibility of the jurisdictional agency and will not be
shared.
5.
Each agency will bill for their costs as outlined in the XX Cooperative Fire Agreement billing procedures.
Cost Share Methodology:
Describe the chosen cost share method for this fire and the details that explain the apportionment. A map must be
included that shows fire area with the methodology applied to that map.
Final Agency Apportionment:
1.
Federal Share:
a.  
USFS  
%  
b.  
BLM  
%  
c.  
FWS  
%  
d.  
NPS  
%  
e.  
BIA  
%  
 
2.
State Share :
a.  
MT  
%  
b.  
ID  
%  
c.  
ND  
%  
d.  
other  
%  
Principal Contacts:
The following personnel are the principal contacts:
Title:
Name:
Agency:
Agency Administrator
Agency Representative
Agency Administrator
Agency Representative
Incident Business Advisor(s)
Incident Commander(s)
Other IMT members as
appropriate
Signatures of Authorized Personnel & Attachments:
This agreement and the apportionment described are our best judgments of fair and equitable agency cost responsibilities.
List and include appropriate attachments (such as I-Suite reports, Aircraft Use Reports, map, etc.):
Original Agreement: _____ (#1)
Supplemental Agreement: Number____ Supersedes Agreement #______ Dated__________
Agency Name:
Address
City, State Zip
Signature: ____________________________________
Date: ______________________
XXNAME, Title
Agency Name:
Address
City, State Zip
Signature: ____________________________________
Date: _______________________
XXNAME, Title
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