CONDITIONAL PERMISSION TO DISCLOSE SOURCE CODES 
AND USER MANUAL 

Enter Software Developer Name Here
(Software Developer) 
[Software Developer] hereby releases the source codes and 

Enter Model Name Here
user manual for the ________________________ [model name] computer model, as required by 
(model name) 
44 CFR Section 65.6(a)(6)(iii) under the following conditions: 
A. Upon the FEDERAL EMERGENCY MANAGEMENT AGENCY's (hereafter 

Enter Software Developer's Name Here
“FEMA”) receipt of a valid request for ________________________’s [Software Developer] source 
(Software Developer) 
code and user manual by an "impacted party," FEMA shall forthwith deliver a certified copy of 

Enter Software Developer's Name Here
the request to ________________________ ’s [Software Developer] escrow agent, who shall be in 
(Software Developer) 
Enter Model Name Here
possession of the ________________________ [model name] source code and user manual. 
(model name) 
The 
escrow agent shall be instructed by the escrow agreement to deliver to the Requester the 

Enter Model Name Here
________________________ [model name] source code and user manual within fourteen (14) 
(model name) 
days of escrow agent's receipt of the certified request. The Requester shall be charged a nominal 
sum for postage, copies, and handling and shall deliver said sum to the escrow agent as a 
condition of the release by escrow agent of the source code and user manual. 

B. Impacted party shall mean an agent of an owner or lessee of land in a community 
who has filed an appeal under the provisions of 44 CFR, Part 65 or Part 67, and can demonstrate 
that the preparation of appeal materials requires review of the source code and user manual. As 

Enter Software Developer's Name Here
a condition precedent to release, ________________________ [Software Developer] shall be 
(Software Developer) 
provided all information used by FEMA in its determination of whether a Requester qualifies as 
an impacted party immediately upon FEMA's receipt of same and no later than five (5) days 

Enter Software Developer's Name Here
prior to delivery of the request described in Paragraph A above to ________________________ 's 
(Software Developer) 
[Software Developer] escrow agent. As an additional condition precedent to release, Requester 

Enter Software Developer's Name Here
shall fully execute and deliver to ________________________ [Software Developer] an original of 
(Software Developer) 
the Disclosure Agreement Regarding Source Codes and User Manual (hereafter "Disclosure 
Agreement"), a copy of which is attached and marked as Exhibit "A". 


Enter Software Developer's Name Here
(Software Developer) 
C. Notwithstanding anything herein to the contrary, ________________________ 
[Software Developer] may take any action it deems necessary, including, but not limited to, the 
prosecution of any protective order to protect its trade secrets and other rights contained in and 
associated with the source codes and user manual. 
D. Enter Software Developer's Name Here
(Software Developer) 
[Software Developer] grants this conditional 

Enter Software Developer's Name Here
permission in consideration of FEMA's acceptance of the ________________________ [model 
(model name) 
name] computer model as an approved computer model as provided in National Flood Insurance 
Program and Related Regulations and in consideration of the terms, covenants, and conditions 
assumed by Requester, as described in the Disclosure Agreement. 

_____________________________ 
Witness 

_____________________________ 
Witness 

_____________________________ 
Witness 

_____________________________ 
Witness 

Enter Model Name Here
(Software Developer) 
[Software Developer] 

By:___________________________________ 
[representative of Software Developer] 

Date:_________________________________ 

Federal Emergency Management Agency 

By:___________________________________ 

Its: ___________________________________ 
[title of FEMA representative] 

Date:_________________________________