Emergency Plan Manual

Alternative Supplier/vendor:___________________________________________________ Title/Version or Model #:_____________________________________________________ Serial #:______________________________________Purchase/Lease Date:____________ Quantity/#Licenses:_____________________________ License Numbers____________________________________________________________ __________________________________________________________________________ Type: 9 Computer Software Primary Supplier/Vendor:_____________________________________________________ Alternative Supplier/Vendor:___________________________________________________ Title/Version or Model #:_____________________________________________________ Serial #:______________________________________Purchase/Lease Date:____________ Quantity/#Licenses:_____________________________ License Numbers:___________________________________________________________ __________________________________________________________________________ 11. If the Agency’s present location of business is not accessible, we will operate from the following location: ____________________________________ Business Name ____________________________________ Address ____________________________________ City, State ____________________________________ Telephone Number ACHA Contact #: __________________________________ CMS Contact #:____________________________________ 12. Local Emergency Contact Information: Police:___________________________________________ Fire Department:___________________________________ Local Emergency Disaster Headquarters:________________ Other:____________________________________________ ________________________________________________ _________________________________________________