Lending Cooperative Mutual-Aid Form

Lending Mutual-Aid Form

If your cooperative is lending mutual-aid to a distressed cooperative. Please complete the form below.

"*" indicates required fields

Cooperative Lending Mutual-Aid Assistance*

If your cooperative is lending mutual-aid to a distressed cooperative. Please complete the form below.

Contact's Name at the Cooperative*

First Last

Primary Contact's Phone Number*

Primary Contact's Email*

Cooperative Lending Mutual-Aid Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Radio Channel Used

Uniform Arc Rating

Gloving Voltages Crews Equipped for

Please upload the signed NRECA Mutual-Aid Agreement

Max. file size: 30 MB.

Are FEMA equipment rates used?

Please upload rates charged for man hours

If rates for man hours are not included in the Mutual-Aid Agreement, please upload.

Max. file size: 30 MB.

Please upload rates for equipment

If rates for equipment are different from FEMA rates or they are not included in the Mutual-Aid Agreement, please upload.

Max. file size: 30 MB.

Date crews are available*

Date of departure*

Estimated Time of Departure*

Estimated Time of Arrival*

Number of days crews are available*

Are rotation crews available?

Crew 1

Type of Crew*

Ranking person on the crew*

First Last

Is the Ranking person the emergency contact for this crew?

Phone number for the ranking person on the crew*

Additional Crew Members

Please use the plus sign to add additional people.

Crew Member's Name

Job Classification

Cell Phone Number

Trucks

Please use the plus sign to add additional trucks.

Truck Description

Truck Identification No.

Trailers

Please use the plus sign to add additional equipment.

Trailer Description

Trailer Length

Axles

Trailer Identification No.

Special equipment en route with crew?

Specialty Equipment

Please use the plus sign to add additional equipment.

Equipment Description

Equipment Specs (Size, HP, Capacity, Size, etc.)

Equipment Identification No.

Crew 2

Only complete Crews 2-4 if you are sending multiple crews.

Type of Crew

Ranking person on the crew

First Last

Is the Ranking person the emergency contact for this crew?*

Phone number for the ranking person on the crew

Additional Crew Members

Please use the plus sign to add additional people.

Crew Member's Name

Job Classification

Cell Hone Number

Vehicle Type

Vehicle Number(s)

Emergency Contact

Emergency Phone Number

Trucks

Please use the plus sign to add additional trucks.

Truck Description

Truck Identification No.

Trailers

Please use the plus sign to add additional equipment.

Trailer Description

Trailer Length

Axles

Trailer Identification No.

Special equipment en route with crew?

Specialty Equipment

Please use the plus sign to add additional equipment.

Equipment Description

Equipment Specs (Size, HP, Capacity, Size, etc.)

Equipment Identification No.

Crew 3

Type of Crew

Ranking person on the crew

First Last

Is the Ranking person the emergency contact for this crew?

Phone number for the ranking person on the crew

Additional Crew Members

Please use the plus sign to add additional people.

Crew Member's Name

Job Classification

Cell Hone Number

Vehicle Type

Vehicle Number(s)

Emergency Contact

Emergency Phone Number

Trucks

Please use the plus sign to add additional trucks.

Truck Description

Truck Identification No.

Trailers

Please use the plus sign to add additional equipment.

Trailer Description

Trailer Length

Axles

Trailer Identification No.

Special equipment en route with crew?

Specialty Equipment

Please use the plus sign to add additional equipment.

Equipment Description

Equipment Specs (Size, HP, Capacity, Size, etc.)

Equipment Identification No.

Crew 4

Type of Crew

Ranking person on the crew

First Last

Phone number for the ranking person on the crew

Additional Crew Members

Please use the plus sign to add additional people.

Crew Member's Name

Job Classification

Cell Hone Number

Vehicle Type

Vehicle Number(s)

Emergency Contact

Emergency Phone Number

Trucks

Please use the plus sign to add additional trucks.

Truck Description

Truck Identification No.

Trailers

Please use the plus sign to add additional equipment.

Trailer Description

Trailer Length

Axles

Trailer Identification No.

Special equipment en route with crew?

Specialty Equipment

Please use the plus sign to add additional equipment.

Equipment Description

Equipment Specs (Size, HP, Capacity, Size, etc.)

Equipment Identification No.

Additional Notes or Information

Lending Mutual-Aid Form

Crew 1

Crew 2

Crew 3

Crew 4

Association of Louisiana Electric Cooperatives