Business No Loss Statement

BUSINESS NO LOSS STATEMENT

RECITALS

WHEREAS, Business Name: is engaged in the business described below and operates at Address: ; and

WHEREAS, the Requesting Party: has requested a formal statement regarding losses (if any) arising from the event described below for the Period Covered: ; and

WHEREAS, the parties desire a written certification that no compensable business loss has been incurred by the business in connection with the referenced event, subject to the terms and representations herein.

SCOPE OF WORK

NO LOSS CERTIFICATION

The undersigned, on behalf of the Business identified above, hereby certifies and warrants that, to the best of its knowledge after reasonable investigation, during the Period Covered there has been:

a) No direct financial loss, loss of revenue, or extraordinary expense attributable to the Event/Incident described below; and

b) No material interruption of normal business operations that resulted in a compensable economic loss; and

The Business further certifies that no claim has been submitted, nor has any claim been settled or paid, in respect of the matters described above that would result in an admitted compensable loss. If any claim is subsequently discovered, the Business agrees to promptly notify the Requesting Party in writing and to provide supporting documentation.

PAYMENT TERMS

In consideration for acceptance of this statement, and only if applicable, Payment Amount: USD shall be paid according to the schedule below.

Late Payment Fee (if applicable): . Interest shall accrue on any overdue amount as specified above until paid in full.

TERM AND TERMINATION

This Statement is effective as of Effective Date: and shall remain in effect until End Date: , unless earlier terminated in accordance with this section.

Either party may terminate this Statement upon written notice of termination to the other party delivered at least Notice Period (days): days in advance. Termination shall not relieve any obligation that accrued prior to termination.

CONFIDENTIALITY

The parties acknowledge that this statement, together with any supporting documents and non-public information exchanged in connection herewith, constitute Confidential Information. Each party agrees to hold Confidential Information in strict confidence and not to disclose it to any third party except as required by law, court order, or with the prior written consent of the disclosing party.

Confidentiality Acknowledgement: By checking this box, the signer acknowledges and agrees to the confidentiality obligations set forth above.

REPRESENTATIONS, WARRANTIES AND INDEMNITY

The Business represents and warrants that the information set forth in this Statement is true, accurate, and complete as of the Effective Date and that it has authority to make the certifications contained herein. The Business shall indemnify and hold harmless the Requesting Party from any losses, liabilities, or expenses arising from any material misrepresentation or omission contained in this Statement.

GOVERNING LAW

This Statement shall be governed by and construed in accordance with the laws of the Jurisdiction: without regard to its conflicts of law principles.

ENTIRE AGREEMENT

This Statement, including the recitals and any attachments or exhibits specifically incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written. Any amendment or modification must be in writing and signed by authorized representatives of both parties.

ADDITIONAL INFORMATION

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