Documents › Board Of Trustees, 2022-07-18

resolution 3 pages

Also attached to this agenda item: Res 113-2022 Fire Mini-Grant

PERMA Grant Disbursement Agreement The PERMA Board of Directors has set aside grant funding for the purpose of addressing member specific issues such as but not limited to remediating a hazardous condition, securing safety equipment beyond the fiscal means of the member or to advance overall workplace safety in an effort to improve the overall performance of the PERMA pool. Grantee: (name)_ (address)_ _______ Policy/Number identifier:_ Amount Awarded: Policy Year(s): Purpose of the Award/Eligible Expenses: (Attach copy of application/agreement): Name of Grant Awarded:_ ____ Disbursement of grant funds are contingent on the following: • Willingness to consider, if offered, a two-year membership agreement • All purchases and hazard remediation must be preapproved by PERMA • The grant shall be used solely for eligible expenses as is stated and in accordance with the terms and conditions of the application/agreement. • Must comply with a PERMA risk management assessment within one year of the award, if not already done so within the prior year of the award. • Not currently in arrears on any payment due PERMA. • Compliant with all terms and conditions of the membership agreement and service plan. The Grant program is a reimbursement program or a split invoicing agreement, The Grantee must provide PERMA with a copies of all invoiced equipment, vendor proof of payment for remediation work and/or training (showing the names and titles of the attendees that participated in the training) for Village of Croton-on-Hudson 1 Van Wyck Street Croton-on-Hudson, NY 10520 WC 0001248-14 $5,000 FY2022 Fire Mini-Grant PERMA to reimburse the member the awarded grant amount. Funding is provided via an ACH bank transfer that should be established prior to the member incurring any expense. If the member should terminate its membership with PERMA after being awarded this grant, the member agrees to provide PERMA with access to all claim data for a period of no less than five years to permit PERMA to measure the long-term impacts of the grant award. PERMA shall not in any event whatsoever be liable for any injury or damage, cost or expense of any nature whatsoever that occurs as a result of or in any way in connection with awarding of this grant and the Grantee hereby agrees to indemnify and hold harmless PERMA and their respective agents, officers, employees and directors (collectively, the "lndemnitees") from and against any and all such liability and any other liability for injury or damage, cost or expense resulting from the payment of the Grant by PERMA to the Grantee in any manner. Grant Disbursement Authorization and Acknowledgement All parties agree that the aforementioned criteria have been reviewed and all contingencies have been met and agreed to. Member Permanent Rep: (signature) _ (printed name) (e-mail address) Member Safety Coordinator: (signature) _ (printed name) _ (e-mail address) PERMA Member Services: (signature) (printed name) (e-mail address) SIGN SIGN SIGN PERMA Risk Management: (signature) (printed name) (e-mail address) PERMA Underwriter: (signature) _ (printed name) (e-mail address) PERMA Executive Director: (signature) _ (printed name) (e-mail address) Date: SIGN SIGN SIGN