2025 Keeping Families Covered Collaborative Partner Agreement

COLLABORATIVE COMMUNITY PARTNER AGREEMENT
LAKE COUNTY OFFICE

3250-B N. Oak Grove Ave., Waukegan, IL 60087 | 224-637-1644
MCHENRY COUNTY OFFICE

4138 W. Orleans St., McHenry, IL 60050 | 815-385-5437
Email: info@keepingfamiliescovered.org

Web: www.keepingfamiliescovered.org
Keeping Families Covered is a nonprofit 501(c3) organization that provides disposable diapers, period supplies, and incontinence products to families. The distribution of those items is a cooperative effort between our organization and a network of community partners.

Keeping Families Covered distributes items through established agencies that work directly with families in need. Those partnerships ensure that: 1) diapers and other essentials get into the hands of those who need them; 2) our programs compliment other services (home visits, case management, health screenings, self-sufficiency programs, job training), and 3) providing families with basic needs will help to connect them with other assistance programs in the community.

We are very intentional with how we grow and who we partner with to distribute our products. Our partners include home visiting programs, shelters, food pantries, townships, churches, schools, healthcare clinics, senior service agencies, foster family programs, and community-based organizations. An agency must have a partnership agreement with us in order to request products for those they serve. Partners must also distribute products according to our guidelines and policies. Our partnership agreement is collaborative and requires each agency to support the mission, and programs, of Keeping Families Covered, throughout each calendar year.

To become a partner, you must complete, and sign, this collaborative partnership agreement as well as pay an annual service fee. Fees are based on a tiered structure and are not payment for products, but contracted service fees. Each tier of partnership includes the maximum number of products that can be ordered each month as well as the annual retail value of those products. Partners can choose the tier(s) appropriate for the size of their agency, budget, and number of children/individuals served each month. The tiered fee model also gives partners the flexibility to pay for only the products they want and need. Order delivery is also available for an additional charge. The contracted service fees are a crucial investment that enables Keeping Families Covered to continue its mission of providing essential support to individuals and families in need. Unused allotments cannot be carried over to the next year or refunded. Changes requested after the initial tier selection(s) is made will require the payment of an additional fee. Annual service fees cannot be pro-rated. If approved and/or renewed for partnership, you will receive an invoice for the annual service fee(s) that must be paid within 30 days of receipt unless other arrangements have been made.

Keeping Families Covered cannot provide items to every agency or organization in need. Selection criteria have been developed to ensure that we establish collaborative and long-term relationships. Our partners must have an excellent reputation in the community, provide a high quality of casework, and limit the duplication of services. We reserve the right to approve or decline applications based on a variety of factors as well as community need.

If your agency has more than one location/site/office, you will need to submit a separate agreement for each site that will be placing orders. Additionally, the contracted service fees will apply to each site that will be placing orders.
AGENCY / ORGANIZATION INFORMATION
Agency / Organization Name:*
Mailing address:*
Website Address:*
Is your agency a 501c3?*

YesNo
Executive Director’s Name:*
Executive Director's Email Address:*
Executive Director's Phone Number:*
Please enter a valid phone number.
Contact Name (if Different):*
Contact Email:*
example@example.com
Contact Phone:*
Agency Mission: *
Brief description of social services provided:*
Counties served (please list all):*
Zip codes of counties served (please list all): *
Number of Families/People Served Each Year:*
Number of Families/People in Need of Diapers Each Year:*
What percentage of your clients fall at or below the Federal poverty line?*
What percentage of your clients receive SNAP benefits? *
What percentage of your clients participate in the WIC program?*
What are the individuals and families you serve most in need of?*

Baby diapersTraining pantsPeriod suppliesIncontinence products
Do you distribute baby diapers and/or training pants?*

YesNo
How many diapers does each child receive and how often?
How many training pants does each child receive and how often?
What size diapers and training pants do you typically need? Check all that apply.*

NewbornSize 1Size 2Size 3Size 4Size 5Size 62T-3T3T-4T4T-5T
Do you distribute period supplies?*

YesNo
If yes, which period supplies? Check all that apply.

PadsLinersTamponsOther
How many period supplies does each person receive and how often?
Do you distribute incontinence products?*

YesNo
If yes, which products? Check all that apply.

Youth / Adult BriefsTabsBed padsPoise padsGuards / InsertsOther
How many products does each person receive and how often?
Is your agency, or any division of your agency, a diaper bank or diaper pantry? See descriptions below.*

YesNo
DIAPER BANKS, DIAPER PANTRIES, AND COMMUNITY PARTNERS
In the diaper bank community, the terms "diaper bank" and "diaper pantry" have specific meanings.

A diaper bank is an organization that receives donations of diapers and/or money to purchase them, and distributes those products to partner agencies who then give them to families in need while providing another service, or basic need, at the same time. Keeping Families Covered is a diaper bank. Our partner agencies are not diaper banks and must not refer to themselves as such.

A diaper pantry is a program that receives donations of diapers and/or money to purchase them, and provides diapers directly to families in need. Keeping Families Covered has a mobile pantry that distributes diapers directly to families at different locations in the community. Our partner agencies are not diaper pantries.

If you are approved to be an agency partner of Keeping Families Covered, you will be a community partner and are facilitating our basic needs products distribution program. Any description, messaging, or wording of your agency's distribution of products from Keeping Families Covered must decribe that you are distributing them in partnership with Keeping Families Covered. If you become a partner agency, we will provide text that you can use to craft your messaging about our partnership. Please let us know if you ever have questions about how to describe our partnership.
Do you receive diapers from any other agency or organization?*

YesNo
If yes, which one(s)?
COMMUNITY PARTNER TERMS AND CONDITIONS
Community partners request and receive items for those they serve directly from Keeping Families Covered. The provision and distribution of items is a joint effort between us and our partner agencies. Partners agree to the following to ensure that the community can continue to receive this service (please initial each item on the line provided):
We agree that all items provided by Keeping Families Covered must be distributed directly to individuals/families of the recipient agency without charge and without discrimination on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, gender identity, or marital/family status.*
We agree that the items provided by Keeping Families Covered are to be used as one part in a broader effort by the recipient agency to assist those in need. The recipient agency, therefore, will not distribute items to individuals or families without providing some level of case management to the individual or family so that they may have the opportunity to work towards self-sufficiency.*
We agree that the items received from Keeping Families Covered may not be sold, bartered, exchanged, or taken by volunteers, officers, clergy, or employees for personal use. Furthermore, no items received may be used for fundraising events, auctions, or raffles. As outlined in the Internal Revenue Code Section 170(3)(3), all items that you receive from Keeping Families Covered must be used solely for the care of the ill, needy, or minors, pursuant to your organization's charitable purpose.*
We agree that the products provided by Keeping Families Covered will not be redistributed to another program, agency, or organization for their use. *
We agree not to alter, change, or dismantle products received from Keeping Families Covered. Bundles of diapers are not to be broken apart or repackaged. No marker, flyers, stickers, labeling, and/or other messaging is to be added to Keeping Families Covered products.*
We agree that we will discuss any significant increase in distribution, orders, and/or changes to supported programs with Keeping Families Covered before implementation.*
We agree to make every effort to avoid duplication of services with other agencies/organizations and to avoid providing items from Keeping Families Covered to individuals/families who will sell, exchange, or barter them. *
We agree to pay the annual service fee(s) in full within 30 days of receiving the invoice unless other arrangements have been made.*
We agree to comply with the annual reporting requirements for Keeping Families Covered and to notify them of any changes in our agency's contact information or mission. Basic demographics will be recorded by the partner agency so that Keeping Families Covered may gather, upon request, information about how many individuals/families are being served by the items that were provided to them. *
We agree to participate in Keeping Families Covered research. Research may include distributing surveys to program staff or product recipients and/or participating in other opportunities to provide Keeping Families Covered with valuable feedback.*
We agree to provide 4 individual/family testimonials to Keeping Families Covered each year to share the impact of our partnership and program.*
We agree that Keeping Families Covered must to be tagged on any social media posts featuring products that we receive from them, distribute to those we serve, or collect on their behalf. *
We agree that if we host a diaper drive to benefit our agency and choose not to include Keeping Families Covered, any sizes/quantities of diapers we collect from the drive will be deducted from our next monthly order. *
We agree that any orders submitted to the Keeping Families Covered Lake County office after 2:30pm are not considered "received" until the next business day. Normal business hours for the Lake County office are 9:00am to 2:30pm Monday through Friday. Normal business hours for the McHenry County office are 10:00am to 12:00pm the first 3 Wednesdays of the month. Orders for the McHenry office must be submitted by 5pm on the Friday prior to the requested pickup date.*
We agree to pick up our orders from Keeping Families Covered during normal business hours (unless we opt to pay for delivery). We understand that an appointment is required for every pick-up and all pick-ups must be handled by an agency representative.*
We agree that if we are more than 30 minutes late for a scheduled pick-up without notifying Keeping Families Covered via phone/email or fail to show up for a scheduled appointment, our order will be returned to inventory.*
We agree that individuals and families who receive diapers from our agency are not eligible to get diapers from the Keeping Families Covered mobile pantry. Individuals/families can only get diapers from one source--an agency partner OR the Keeping Families Covered mobile pantry.*
We agree that we will not refer individuals or families to visit or contact Keeping Families Covered directly for items if they are receiving help from our agency. We understand that it is our responsibility to ensure that our staff and volunteers are aware of this policy.*
We agree that Keeping Families Covered may reject or cancel partnership with our agency at any time due to the lack of resources, the failure to comply with partnership requirements, the falsification of information, or various other reasons.*
We agree to indemnify, defend, and hold harmless Keeping Families Covered from any and all liabilities related to products received as donations or purchased by Keeping Families Covered from a supplier and then donated to our partner agency. Furthermore, we hereby forever release and discharge Keeping Families Covered, its officers, directors, staff, and volunteers from any and all claims for any known, unknown, or future damages because of the products.*
COMMUNITY PARTNER ANNUAL SERVICE FEES, ORDERS, AND BUDGET
Annual Fees for Service - SEE TIERED FEE STRUCTURE BELOW (payable in full via within 30 days from receipt of the invoice unless other arrangements have been made)*

We have read and agree to the terms of the Community Partner Agreement.We understand that the annual service fees are a crucial investment that enables Keeping Families Covered to continue its mission of providing essential support to individuals and families in need. Unused allotments cannot be carried over to the next year or refunded regardless of any circumstances that may arise.We understand that invoices for the annual service fee(s) must be paid within 30 days of receipt unless other arrangements are made.We understand that any changes requested after the initial tier selections are made will require the payment of an additional fee.We understand that if our agency has more than one location/site/office, a separate partner agreement will need to be submitted for each site that will be placing orders. Additionally, we understand that the contracted service fees will apply to each site that will be placing orders.
We choose the following BABY DIAPERS tier for our agency:*

Tier 1 - $1,000Tier 2 - $3,000Tier 3 - $6,000Tier 4 - $8,000None
We choose the following TRAINING PANTS / PULL-UPS tier for our agency:*

Tier 1 - $500Tier 2 - $1,000Tier 3 - $1,500Tier 4 - $2,000None
We choose the following YOUTH / ADULT BRIEFS & INCONTINENCE PRODUCTS tier for our agency:*

Tier 1 - $1,000Tier 2 - $3,000Tier 3 - $6,000Tier 4 - $8,000None
We choose the following PERIOD KITS (MENSTRUAL PADS) tier for our agency:*

Tier 1 - $350Tier 2 - $630Tier 3 - $1,260Tier 4 - $1,890None
We choose the following STARTER STACKS tier for our agency:*

Tier 1 - $100Tier 2 - $200Tier 3 - $400Tier 4 - $500None
We would like to add ORDER DELIVERY for our agency and understand that we are opting-in for delivery for all 12 months of the year (Lake County: Tuesday/Thursday delivery and McHenry County: Wednesday delivery):*

Yes - $3,000 ($250 per delivery)No
Total contracted service fees due:*
Our monthly orders will be placed as follows:*

In bulk (sufficient storage space required at your facility)By child/individual/family (bagged and labeled)
Our monthly orders will be submitted to the following office:*

Lake County (Waukegan)McHenry County (McHenry)
REQUIRED: Annual budget for the agency/organization:*
Signature of Executive Director:*

Powered by Jotform SignClear
Printed Name of Executive Director:*
Date:*

MonthDayYear
Date
Please note that incomplete agreements will not be considered or accepted.

Every agreement received is carefully reviewed and thoroughly vetted by the Keeping Families Covered management team. This process can take 3-4 weeks to complete for NEW partners. Newly approved agencies will be notified via email and additional information will be provided at that time. Partnership renewals are processed in 5-7 business days.
KEEPING FAMILIES COVERED OFFICE USE ONLY
Date Agreement Received:

MonthDayYear
Date
Date of CEO Review:

ApprovedDenied
Partner Status:

NewRenewal
KFC CEO Initials
Date Agency Notified of Decision

MonthDayYear
Date
Agency Partner Lists Updated (Email, Website, Word)
example@example.com
Annual Service Fee(s) Paid:

YesNo
Payment method:

CheckACH
Check Number:
Amount:
Date

MonthDayYear
Date
Should be Empty:

COLLABORATIVE COMMUNITY PARTNER AGREEMENT

LAKE COUNTY OFFICE

MCHENRY COUNTY OFFICE

AGENCY / ORGANIZATION INFORMATION

DIAPER BANKS, DIAPER PANTRIES, AND COMMUNITY PARTNERS

COMMUNITY PARTNER TERMS AND CONDITIONS

COMMUNITY PARTNER ANNUAL SERVICE FEES, ORDERS, AND BUDGET

KEEPING FAMILIES COVERED OFFICE USE ONLY