Contractors Application Form

CONTRACTORS APPLICATION FORM

This Contractors Application Form (the Agreement) is submitted for the purpose of prequalification and potential engagement of the applicant by the hiring entity. Completion of this form constitutes the applicant's representation and certification of the information provided and agreement to the terms set forth below.

WHEREAS

WHEREAS: Contractor Name:

WHEREAS: Hiring Entity Name: seeks to engage qualified contractors to perform specified services under terms and conditions set forth in this application and any subsequent contract.

WHEREAS: The applicant represents that the information provided is accurate, that the applicant maintains necessary licenses and insurance, and that the applicant will comply with safety, regulatory and contractual obligations if engaged.

APPLICANT INFORMATION

Individual    Sole Proprietor    LLC    Corporation    Partnership

LICENSES AND INSURANCE

Worker Compensation Provided: Yes    No

REFERENCES

SCOPE OF WORK

Describe the specific services, deliverables, and standard of performance to be performed if engaged. Include typical materials, equipment, and expected project milestones.

PAYMENT TERMS

Proposed Contract Amount: $

Standard Invoice Due (days):     Late Fee:

Invoices shall include reasonable itemization of labor and materials. Payment disputes must be submitted in writing within 15 days of invoice receipt.

TERM AND TERMINATION

Proposed Start Date:     Proposed End Date (if applicable):

Either party may terminate any subsequent engagement for convenience upon written notice delivered no fewer than days, subject to payment for work performed to the effective date of termination and any reasonable demobilization expenses.

CONFIDENTIALITY

Applicant acknowledges that in the course of performance, the applicant may receive or have access to confidential information of the hiring entity. Applicant shall: (a) hold confidential information in strict confidence; (b) not disclose confidential information to third parties except as required by law or with express prior written consent of the hiring entity; and (c) use confidential information solely for purposes of performing the services. This obligation shall survive termination of any engagement for a period of three (3) years, or longer if required by applicable law.

Applicant acknowledges and agrees to the confidentiality obligations: I acknowledge and agree.

REPRESENTATIONS AND WARRANTIES

Applicant represents and warrants that all information provided herein is true and complete; that applicant has authority to enter into engagements and to bind the business entity; and that applicant is in good standing with applicable licensing and tax authorities. Applicant will comply with all applicable laws, codes and regulations and will maintain required insurance coverage while performing work.

GOVERNING LAW; ENTIRE AGREEMENT

Any contract formed as a result of this application and any ensuing purchase orders or agreements shall be governed by the laws of the state of the hiring entity's principal place of business, without regard to conflict of law principles. This form, together with any written engagement letter, constitutes the entire agreement between the parties with respect to prequalification and supersedes all prior representations, negotiations and agreements, whether written or oral.

Applicant further acknowledges that submission of this form does not guarantee award of work and that the hiring entity reserves the right to accept or reject any application in its sole discretion.

CERTIFICATION

By signing below, the undersigned certifies under penalty of perjury that the information provided in this Contractors Application Form is true, correct and complete, that the undersigned has the authority to bind the applicant, and that the applicant consents to verification of any information provided.

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