LICENSE TO USE - A MATTER OF BALANCE - LAY LEADER MODEL 'his License Agreement is between your org. nization and Par��orship for Healthy Aging
Please tomplete 1 of iginal, listijIg the
Liarne.of Your car artizatiort in the blank spaces.
Have the lead of your or 2�nizat'it 0 sign it bhi lqk)An elate at the bdtt M right-hand side of page 2.
y `
List'ilic names ofthe Master Trainers to be covered under your,Iicense on pagc .
License to Use
.A IVMatLe of�aj;jnce/Lay Leader.Model
lYll. AGRV,j'MFN I,'is entered into tlrts .05101 /13 . by`the Geriatric Resource Network
d/1a1 Partnership for Healthy g in;(�`l'FhiA a mart-p-ofit corporation incor oraled in the State
Of Maine with a principal.business at;1 I0.Free Street,Portland, Maine, 0410.4:and
the City at Cl rnate r _, located.at . 100 S_ M rtle Aver►tie
{Cratriztrorr leianae} (Organization Address)
Clearwater, FL 33756
hcrctts,the p1 MOs holds,title to training
materials including a comprehensive facllitittor
manna!entitled"".'Matter of:Balaijc� J.,ay !,eider Model"
("MOB".); an
1 hereas; ttie Clt pf Cle�r+trat�r dcsi r s to acquire the right;to:t.tse
1013 in order to,among other thin train V lurntecr hay.Leaders:to serve as M013 Coachesp
Now,TtiFRrr oRE in consideration of their mu.
tLtal' and:the n�titttal undertakings
hererii or�mimn d, tht:parties a ree
1. Grow. of License: hereby grants to the City of Clearwater
tlt 'r n- elt si t tt rt trat sft�ri�t le ri lit to iise MOR in accordance with.the Master"T'r�in�r
Manual, Master Trainer Jab 1:3escriptiork MOB Coach Job,Descr ption;MOB Coach Manual,
and evaluation tool as they tray reasonably be:amended°front time to time by PFHA
.propriatc;outcoine meastttctxtcnt parameters fnr this pro rain are the follow 6 Falls
Efficacy,Falls Mat agement, l='alga Control, and xercise ll ever. pFI-1A does not make any ether
assurances regarding other,outcome musures.
2. Restriclians. Licensee shall not(aj sell,distribute or sublicense MOB or arty portion
thei.vol,(b.)modify or adapt MOB, or(c) translate,reverse ett�inesar,or create any derivative
work of MOB. Licensee shall only rise mOB in the manner authori�c�{: Copies of'rnater ials afire
to be made only try extent:necessary to conduct pro ram with seniors..
, C.redit. Any pmb.l ication.chi. IOB,or any adaptation them whefl ri r firm print,video or
comptitet based publication,shall boat-thc:foll wi tg credit
-
A.Wtter of Palance:Maw ing Concerns"born fzalls/ttoluntoer Lay Loader Model<02006
11W larcrgrar r is taased can"Fear of Falling: A Matter.of Balance'C opyri lit t 19,95'.rrrrstees of Boston
University.All rigglm reserved.
Used and t,d ipted:by perinissjon.of Boston university.
lii€ltriries regording it w tariginal program.i ay be directed to Boston'Univeoity,.tlealilr��.lX5abiliiy
Research Imlitute,.53.Liay torte.Road,:E3tmon,Massaclttrsetts,0221.5. A Matter:€ar.Balance teas created with
serpport from the National:li Atrrte on Aging.
A Matter car alance txty leader Model was developed by rr grant rroin the Administration on.Aging(#uhf AM2780i.
DA11 ri hts.r servedy l I�tineLlerrltlr's Pirtnership for Healthy Agin&
1
d 1h..de mn 'Cation. 1-0 the extent permitted by lass; the city of Clearwater
shall at all trines during the term of this License and thereafter, defend and hold PFFIA., its.
trtast. es,off cers,,employees, agents and affiliates(togetlicr, "ind mnite&') harmless:frvrn and
ag irist all claims,"starts; do. ands, liability and expmes, including legal.expenses and
reasonable attorneys' fees. arising out oa"any rie iigent acl or carrtissitin of
r pursiiftntt o.this Agreement,
5. 12e:sjvnsibrlityfor Acts or Orarissioqs..
the.Oty of Q. earwater
agrees to accept and tae responsible for its own pacts or omissions. as well as chose acts or
emissions of its eirtpleyees, agents.and<independent:contractors and nothing iri this.A'greerwmt
shall be interpreted or.construed,to place any such responsibility on PFIIA.
6. EXCL SKW) , ,IN NO EVENT SHALL PFHA BE LIABLE FOR SPECIAL,
INCIDENTAL,CONSEQUENTIAL, PUNITIVE O TOR I DAMAGES, INCLUDING,
WITHOUT L1MIT�ITION,ANY DAII�I��GES ESULTING FROM LOSS OF USE' LOSS OF
DATA, LOSS OF'PROFITS OR LOSS OF BUSINESS ARISING OUT OF OR IN
CONNECTION WITH THIS AGREEMENT, I J [JSE OP 'I'FI� MOI3 OIL OF r�NY C7 I°1�I$R
OBLIGATIONS RELATING TO THIS AGREEMENT fME•'NT OR fiHE N1013, WFw TI IC R OR NOT
LICENSOR HAS BEEN ADVISED Of TFII-'P ?SSIBILITY OF SUC IqDI?11v1AGES'. TILE
MOB AND ALL ASSOCIATED M.ATf'RI LS '1'C CST ARE THE SUBJEC ' OFT-11S
AGREEMENT ARE DELIVERED "AS 15".I:WEVERY RESPECT.
7. Toy of
Agreement. ` his agrecr'01 Will re"hill in effect-undl cancelled by either
party.Capon 30 days prior written notice. If a�-eement is cancel led'by MIA, then
a
agrees that it Will terminate use of the M013.
IN W ITNESS WHEREOF, the parties hereto, each acting under:clue and proper author tys have set
their hands and seals as of the date first'abo e written.
Main&Flealth's Partnershi f6t I-lealtla A t City of Cleamater
Your Organization Nan'e
Si uaiture(th blue ink)
Kevin Dunbar, Dir., Paft and.Recreation Dept;.
Francs G. McGinty
Executive Vice Presideat and Treasurer Printed'Ie amia Ind Title.
a;ncHen-Ith _ (727)793-2339
Printed l atne and Title phone
2t)7�.1-7120 . . . . May 1,2013:
Pbotle. Date
kerry.rnarse1e.k rnyclearwater.calm
Date Email Address
Muster TrAiiier( )coy
eired under tW tkeose:
Name, Kerry Marsalek, MA Date,June 5,24.13
Nara e :Sheryl Crutchfield, MA. �date June 2413
Name: a
Name: Date
Name: Date
Name: Date
ame. Tate
Date .
Name: Date
-Name-, Date
'lease Mgil signed original of.thisticense Agreement to..
Partttersh l'or.t -.troy Agin
1.10 Free Street
Portland, ME 041,61
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