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Attachment 1 <br />STATEWIDE MUTUAL AID AGREEMENT <br />Type or print all information except signatures <br />Form B <br />PART I <br />TO BE COMPLETED BY THE REQUESTING PARTY <br />Date: <br />ime: <br />HRS <br />local <br />Mission No: <br />Point of Contact: <br />Telephone No: <br />E-mail <br />address: <br />Re uesdn Pa <br />Assisting Party: <br />Incident Requiring Assistance: <br />Type of Assistance/Resources Needed use Part IV for additional space) <br />Date & Time Resources <br />Needed: <br />Location <br />[(address): <br />Approximated Date/Time Resources <br />Released: <br />Authorized Official's Name: <br />Signature: <br />Title: <br />Agency: <br />PART II <br />TO BE COMPLETED BY THE ASSISTING PARTY <br />Contact Person: <br />Telephone No: <br />E-mail <br />address: <br />Type of Assistance Available: <br />Date & Time Resources Available <br />To: <br />Location (address): <br />Approximate Total cost for mission: <br />$ <br />Travel: $ <br />Personnel: $ <br />Equipment & <br />Materials: $ <br />Contract Rental: $ <br />Logistics Required from Requesting Party Yes <br />(Provide information on attached Part IV) No <br />Authorized Official's Name: I <br />I Title: <br />Date: <br />Signature: <br />Local Mission No: <br />PART III <br />TO BE COMPLETED BY THE REQUESTING PARTY <br />Authorized Official's <br />Name: <br />Tide: <br />Signature: <br />Agency: <br />Revised: March 2018 54 <br />4Page 1 <br />