Affiliation Proof Document

AFFILIATION PROOF DOCUMENT

This Affiliation Proof Agreement ("Agreement") is made and entered into as of by and between:

RECITALS

WHEREAS, Affiliated Entity represents that it maintains a formal affiliation, ownership interest, or controlling relationship with the organization identified as (the "Affiliated Organization") for the purposes described herein;

WHEREAS, Requesting Party requires written confirmation of the foregoing affiliation to permit access to certain benefits, discounts, contract eligibility or regulatory filings as set forth in this Agreement; and

WHEREAS, Affiliated Entity and Requesting Party desire to set forth the terms under which Affiliated Entity will certify and demonstrate the affiliation, and the permitted uses of such certification.

AFFILIATION IDENTIFICATION

Corporation LLC Individual Nonprofit Other

SCOPE OF AFFILIATION USE

Describe the specific purposes for which Requesting Party may rely on this Affiliation Proof (e.g., bid qualification, contractual discounts, regulatory submission). Include any limitations on scope, permitted recipients, and expiration of authorization.

SUPPORTING DOCUMENTS

The following documents, if applicable, accompany this Affiliation Proof to substantiate the relationship. Check all that apply and identify document details.

Corporate resolution or board minutes confirming affiliation Certificate of good standing or equivalent Letter of authorization or power of attorney Other (describe):

PAYMENT TERMS

In consideration for preparing, certifying and furnishing the Affiliation Proof and related documentation, Requesting Party shall pay Affiliated Entity as follows:

TERM AND TERMINATION

This Agreement commences on the Start Date and continues until the End Date unless earlier terminated in accordance with this section. Start Date: . End Date: .

Either party may terminate this Agreement for material breach that remains uncured after the notice period set forth above. Termination shall not relieve Requesting Party of payment obligations for services rendered or costs reasonably incurred prior to termination.

REPRESENTATIONS, WARRANTIES AND CERTIFICATION

Affiliated Entity represents and warrants that it is duly authorized to provide the foregoing Affiliation Proof, that the statements contained in this Agreement and any attached supporting documents are true and correct to the best of its knowledge, and that no material information has been omitted. Requesting Party acknowledges that reliance on this Affiliation Proof is subject to the limitations and conditions set forth herein.

CONFIDENTIALITY

The parties acknowledge that certain information exchanged in connection with this Agreement may be confidential. Each party agrees to treat Confidential Information of the other with at least the same degree of care it uses to protect its own confidential information but no less than reasonable care, and to use Confidential Information solely for the permitted purposes set forth in this Agreement. Confidential Information does not include information that is publicly available other than by breach of this Agreement or that is required to be disclosed by law, in which case the disclosing party shall provide prompt notice to the other party.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to its conflict of laws principles. Venue for any dispute arising under this Agreement shall be exclusively in the state or federal courts located within that state.

ENTIRE AGREEMENT

This Agreement, together with any exhibits and supporting documents identified herein, constitutes the entire agreement between the parties regarding the subject matter hereof and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral. No modification shall be binding unless executed in writing and signed by authorized representatives of both parties.

MISCELLANEOUS PROVISIONS

Neither party may assign this Agreement without the prior written consent of the other, except that Affiliated Entity may assign to an affiliate or successor entity in connection with a merger or sale of substantially all of its assets. If any provision is held invalid, the remaining provisions shall remain in full force and effect.

ACKNOWLEDGMENT

Each party acknowledges that it has read and understands this Agreement, that it has had the opportunity to consult with counsel, and that it enters into this Agreement voluntarily and with full authority to bind the party on whose behalf it signs.

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