Certification Submission Form

CERTIFICATION SUBMISSION FORM

Parties

Applicant Name:

Certifying Entity:

Recitals

WHEREAS, Applicant seeks formal certification of the services, processes, products, or systems described in this submission and requests evaluation by Certifying Entity in accordance with the standards and procedures set forth in this form; and

WHEREAS, Certifying Entity is duly authorized and qualified to evaluate compliance with the certification criteria identified in this submission and to issue certifications upon satisfactory demonstration of conformity; and

WHEREAS, the parties desire to set forth the terms, scope, fees, and obligations attendant to the certification submission and any resulting issuance of a certificate.

Certification Details

Submission Reference Number:

Requested Effective Date:   Requested Expiration Date (if applicable):

Scope of Work

Describe the scope of evaluation, deliverables, and any exclusions. Include locations, processes, or product lines intended for certification.

Payment Terms

Total Fee Amount:

Late Payment Fee: . Fees are chargeable on any overdue balance from the payment due date until paid in full.

Declarations and Representations

The Applicant represents and warrants that all information provided in this submission and accompanying documentation is true, complete, and accurate to the best of Applicant's knowledge. Applicant understands that material misstatement or omission may result in denial, suspension, or revocation of certification.

Specification sheets and technical documentation
Test reports and laboratory data
Process descriptions, SOPs, or quality manuals
Other:

Confidentiality

Certifying Entity agrees to treat non-public information disclosed by Applicant in connection with this submission as confidential and shall not disclose such information except (a) as necessary to perform the evaluation, (b) in accordance with applicable law, or (c) pursuant to a court order. Confidential information does not include information that was already known to Certifying Entity without obligation of confidentiality, becomes publicly available through no fault of Certifying Entity, or is independently developed by Certifying Entity.

Term and Termination

Term Commencement Date:   Term End Date (if fixed):

Either party may terminate this submission and any resultant certification activities for material breach by the other party if such breach remains uncured thirty (30) days after written notice. For convenience, either party may terminate upon providing days' prior written notice to the other party; Applicant remains liable for fees for work performed through the effective date of termination and any non-cancellable costs incurred by Certifying Entity.

Governing Law

This Certification Submission Form and any certification issued pursuant to it shall be governed by and construed in accordance with the laws of the state of: , without regard to its conflicts of law principles.

Entire Agreement

This document, together with any attachments, schedules, and referenced standards expressly incorporated herein, constitutes the entire agreement between Applicant and Certifying Entity with respect to the subject matter and supersedes all prior and contemporaneous agreements, understandings, and representations, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

Applicant Certification Statement

By signing below, Applicant certifies that the information provided in this form and accompanying documentation is true and complete, that Applicant will permit reasonable access for evaluations and audits, and that Applicant accepts the payment, confidentiality, termination, and governing law provisions set forth above.

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