Crime Free Certification Form

CRIME FREE CERTIFICATION FORM

WHEREAS RECITALS

WHEREAS, the undersigned Property Owner/Manager certifies that the property known as (the Property) is enrolled in or seeks certification under the Crime Free Program described herein; and

WHEREAS, the Program Administrator provides crime prevention training, property safety assessments, and certification of compliance subject to the terms, inspections, and reporting obligations set forth below; and

WHEREAS, the parties intend by this Certification to record the Property's compliance with minimum crime prevention standards and the parties' mutual obligations during the Term of certification.

PROPERTY AND APPLICANT INFORMATION

Individual   Corporation   LLC   Partnership   Other:

CERTIFICATION OF COMPLIANCE

By checking each applicable box and signing below, the Applicant affirms that the Property meets the following program requirements and that the Applicant will maintain such measures for the Term of certification.

Applicant has adopted and enforces a tenant screening and lease addendum consistent with crime prevention objectives.

Applicant or designated manager has completed required Crime Free training on .

Security measures currently implemented at the Property (check all that apply):

Deadbolt locks on exterior doors   Peepholes or viewing devices   Exterior security lighting
Secured fencing/gates   Reinforced screens/locks on windows   Surveillance or monitored alarms

Applicant agrees to promptly report to the Program Administrator and to local law enforcement all incidents of criminal activity that occur on the Property and to cooperate with any follow-up inspections, investigations, or remedial measures required to maintain certification.

SCOPE OF WORK

PAYMENT TERMS

Program Fee Amount: $

Late fee for unpaid amounts: . Applicant acknowledges that failure to timely pay fees may result in suspension or revocation of certification.

TERM AND TERMINATION

Certification Term begins on and ends on unless earlier suspended or revoked in accordance with this form.

Certification may be suspended or revoked by the Program Administrator upon material noncompliance with program requirements, failure to remedy identified security deficiencies after written notice, or breach of payment obligations. Applicant retains the right to cure within the notice period unless immediate suspension is required to protect public safety.

CONFIDENTIALITY

The parties agree that records and information exchanged pursuant to this Certification concerning security plans and incident reports that are not public records shall be maintained confidentially to the extent permitted by law. Confidential information shall not be disclosed to third parties except as required by law or with the prior written consent of the disclosing party.

GOVERNING LAW

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

ENTIRE AGREEMENT

This form, together with any referenced program policies and the Scope of Work, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior oral or written agreements. Any amendment must be in writing and signed by both parties.

REPRESENTATIONS; CERTIFICATION WARNING

The Applicant represents and warrants that all information supplied on this form is true and complete. Knowingly submitting false information or failing to disclose material facts may subject the Applicant to denial, suspension, or revocation of certification and other administrative or legal actions.

I certify under penalty of perjury that the foregoing is true and correct and that I am authorized to execute this Certification on behalf of the Applicant.

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