Contractor Registration Form

CONTRACTOR REGISTRATION FORM

This Contractor Registration Form is entered into by and between Company Name: (hereinafter "Company") and Contractor Name: (hereinafter "Contractor"), effective as of .

RECITALS

WHEREAS, the Company requires qualified contractors to perform services on an as-needed basis for projects and operations under the Company's control; and

WHEREAS, the Contractor represents that it possesses the necessary licenses, qualifications, experience, personnel, and insurance to perform such services in accordance with applicable law and industry standards; and

WHEREAS, the parties desire to record Contractor's registration data, assurances, and certifications to permit Contractor's engagement on Company assignments.

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties agree as follows:

1. DEFINITIONS

For purposes of this Form, "Services" means the work to be performed by Contractor for Company pursuant to separate task orders, purchase orders, or statements of work. "Registration Data" means the information and documents provided by Contractor on this Form and attachments.

2. SCOPE OF REGISTRATION

Completion of this Form registers Contractor with Company for potential engagement. Registration does not guarantee assignment of work and does not create a contract of employment. Specific engagements will be governed by separate agreements or work orders executed by the parties.

3. CONTRACTOR INFORMATION

4. LICENSES AND QUALIFICATIONS

Contractor warrants that it maintains all licenses, permits, registrations, and qualifications required to perform Services. Provide primary license type: , License No.: , Issuing Authority: .

5. INSURANCE

Contractor shall maintain insurance coverages appropriate to the Services. Provide primary insurer: , Policy No.: , Coverage Limits: , Policy Expiration: .

Contractor shall provide certificates of insurance evidencing required coverage upon request and shall name Company as additional insured where required by the applicable engagement.

6. REPRESENTATIONS AND WARRANTIES

Contractor represents and warrants that: (a) all information submitted on this Form is true, complete, and accurate; (b) Contractor has the authority and capacity to enter into engagements with Company; (c) Contractor will perform Services in a professional manner in accordance with industry standards; and (d) Contractor will promptly notify Company of any material change to Registration Data, licensure, insurance, or ability to perform Services.

7. COMPLIANCE WITH LAWS; SCREENING

Contractor shall comply with all applicable federal, state, and local laws, regulations, codes, and ordinances. Company may require background checks, drug screening, or other clearance as a condition to assignment; Contractor consents to such screening when required and warrants that Contractor and its personnel meet Company’s screening criteria.

8. INDEMNIFICATION

Contractor shall indemnify, defend and hold harmless Company and its officers, directors and employees from and against any and all claims, liabilities, losses, damages, costs and expenses (including reasonable attorneys' fees) arising out of or resulting from Contractor's performance of Services, except to the extent such claims arise solely from Company's gross negligence or willful misconduct.

9. CONFIDENTIALITY

Contractor may have access to Company confidential information. Contractor shall keep such information confidential, shall not use it except to perform Services for Company, and shall return or destroy confidential materials upon Company's request. The obligations in this section survive termination of registration.

10. TERMINATION; SUSPENSION

Company may suspend or terminate Contractor's registration or any assignment at any time for cause, including breach of this Form, loss of required licensure or insurance, unsatisfactory performance, or results of required screening. Suspension or termination of registration shall not relieve Contractor of obligations accrued prior to such action.

11. NOTICES

All notices required by this Form shall be in writing and delivered to the addresses below by personal delivery, nationally recognized overnight courier, or certified mail. Notices shall be deemed given upon receipt.

12. AMENDMENTS; WAIVER

This Form may be amended only by written instrument executed by authorized representatives of both parties. The failure of either party to enforce any provision shall not constitute a waiver of that provision or any other provision.

13. GOVERNING LAW

This Form shall be governed by and construed in accordance with the laws of the state of , without regard to its conflict of law principles.

14. ENTIRE AGREEMENT; SEVERABILITY

This Form, together with any attachments and any subsequently executed work orders or agreements expressly incorporating this Form, constitutes the entire agreement between the parties regarding Contractor's registration and supersedes all prior representations and agreements concerning the subject matter. If any provision is held invalid, illegal, or unenforceable, the remaining provisions shall remain in full force and effect.

15. CERTIFICATIONS

By signing below, Contractor certifies that the information provided in this Form is true and complete, that Contractor will maintain required licensure and insurance while registered with Company, and that Contractor will promptly notify Company of any material change to such information.

Yes

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