UNIVERSITY OF MONTANA

Cooperating Agency Agreement

  • The Cooperating Agency Agreement relieves your agency’s representatives of personal financial responsibility for lost or broken loan items. Such costs would be absorbed by the agency, not the agency’s individual employees, thus encouraging your team members to explore independence-enhancing tools to better serve your clients, patients, or students.

  • PURPOSE

    The purpose of this agreement is to outline the Cooperating Agency Agreement of the MonTECH Program at the University of Montana. This program increases access to assistive technology for demonstration, evaluation, or trial use by Montanans with disabilities in order to determine the appropriateness of a device to meet those individuals’ needs before a purchase is made. Equipment available through this loan program was purchased with federal or state funds for the benefit of individuals with disabilities and is not intended to be used for fiscal gain by any individuals or entities.

  • MonTECH will:

    1. Assist the agency requester (therapist, teacher, or staff) in determining the most appropriate technology for the user/situation.
    2. Provide a copy of the Equipment Loan Agreement to the borrower when the equipment is shipped. It is understood that the staff member signing off as Borrower is acting as a representative of the Cooperating Organization.
    3. Provide, to the best of our abilities, equipment that is clean and in good working order. Devices will be charged or the batteries will be tested before shipping, but they may need recharging or replacement batteries upon arrival. Instruction manuals, materials, and accessories will be provided as necessary.
    4. Package equipment safely for shipping, in plenty of cushioned materials and in a sound container.
    5. Insure equipment for its value and note that value on the packing slip so that the Borrower may insure the equipment for the same amount when returning it.
    6. Assist borrowers by providing information and referrals for potential equipment funding sources and equipment manufacturers and vendors when a decision to explore purchasing has been made.
    7. Pay for shipping from MonTECH to the borrower. Return shipping is the responsibility of the Borrower.

  • The Cooperating Agency will:

    1. Inform all staff representatives of this agreement and their ability to utilize MonTECH’s device loan program, or designate specific staff members who may utilize the program and notify MonTECH of who is eligible to borrow equipment. In doing so, the organization will inform eligible staff of their responsibilities as outlined in this agreement and the equipment loan agreement provided with each loan.
    2. Be responsible for making appropriate loan decisions or seek assistance from MonTECH staff, professionals or other trained consultants who are qualified to assist in making these determinations.
    3. Provide information about who will be using the equipment, for purposes of MonTECH’s federal reporting. Consumer names may be abbreviated, but required information includes: consumer age, county of residence, type of disability, and the purpose of the loan.
    4. Assure that devices will be handled by qualified staff. MonTECH can provide technical assistance to some extent, but with more sophisticated devices, an on-site professional's expertise is required.
    5. Provide follow-through for the person using the device, whether that entails extended borrowing from MonTECH or purchase of equipment directly from the device manufacturer or local vendor.
    6. Be ultimately responsible for the condition of the borrowed equipment while it is on loan to this organization. This involves keeping devices clean and adequately charged, replacing standard alkaline batteries if necessary, assuring that devices are handled properly and that sensitive electronics are protected from exposure to extremes of heat and cold.
    7. Complete and return the satisfaction survey supplied by MonTECH for each device borrowed so MonTECH can provide anonymous information required for federal reporting.
    8. Package equipment safely for shipping (preferably in the same packaging in which it was received) and pay expenses to ship it back to MonTECH, including the expense to insure items for the value listed on original packing slip.
    9. Reimburse MonTECH for the cost of repair for any equipment damaged or replacement of any equipment lost, stolen, or destroyed while on loan to the Cooperating Organization or representatives thereof.
    10. Be responsible for fees assessed by MonTECH for failing to return equipment. The dollar amount assessed by MonTECH will be determined by the value of the device.
  • The director of the organization, not necessarily the primary contact for this cooperating agency agreement.
  • If different from the director of the organization.
  • If different from the director of the organization.
  • If different from the director of the organization.
  • MM slash DD slash YYYY
    Cooperating agency agreements are typically effective the date they are approved by MonTECH and remain valid for 1 year. If you desire a more restrictive effective date range, enter it here.
  • MM slash DD slash YYYY
    Cooperating agency agreements are typically effective the date they are approved by MonTECH and remain valid for 1 year. If you desire a more restrictive effective date range, enter it here.
  • If only select representatives are allowed to borrow equipment and be covered by this Cooperating Agency Agreement, name them here.

  • Authorization

    By submitting this form, the director of the organization agrees that all information submitted is correct and accurate, and that director and organization agree to abide by the terms of this contract.

  • This field is for validation purposes and should be left unchanged.