Decontamination Form

DECONTAMINATION SERVICE AGREEMENT AND WORK AUTHORIZATION

Client Name:    Contractor Name:

Effective Date:

WHEREAS

WHEREAS, Client requires professional decontamination and remediation services at the Site described below to remove, neutralize, or otherwise render safe biological, chemical, radiological, or other hazardous contamination; and

WHEREAS, Contractor represents that it possesses the necessary licenses, training, personnel, equipment, insurance and permits to perform the specified work in accordance with applicable law and industry standards; and

WHEREAS, the parties desire to set forth the scope, payment, scheduling, and legal terms governing Contractor’s performance and Client’s authorization for Contractor to commence work.

SITE INFORMATION

Contact Phone:    Contact Email:

SCOPE OF WORK

Contractor will perform the decontamination services described below. Specific tasks, methods, and limits of work must be set forth prior to commencement. Contractor shall not materially deviate from this Scope without Client’s written approval.

Biological (bloodborne pathogens, viruses)    Chemical residues    Radiological    Other:

Wipe-down surface disinfection    Fogging/misting    Contaminated material removal and disposal    Other:

PAYMENT TERMS

Contract Price: $

Deposit Required: $    Final Payment Due: days after invoice

Late Payment Fee: . Client shall be responsible for reasonable collection costs and interest as stated above.

TERM AND TERMINATION

Term Commencement Date:    Termination Date (if fixed):

Either party may terminate for material breach if the breaching party fails to cure within days after written notice. Client may terminate for convenience upon days’ written notice; Client shall pay Contractor for work performed and reasonable demobilization costs.

CONFIDENTIALITY

Each party shall maintain in confidence all non-public information received from the other party in connection with this Agreement and shall not disclose such information except to employees, agents or subcontractors who have a need to know and who are bound by confidentiality obligations. Confidential information does not include information that is publicly known through no fault of the receiving party or that is required to be disclosed by law, provided the disclosing party gives prompt notice and cooperates to seek protective treatment.

COMPLIANCE, SAFETY AND CLEARANCE TESTING

Contractor shall perform work in compliance with applicable federal, state and local laws and regulations, industry standards, and shall furnish all required permits. Contractor shall use appropriate personal protective equipment and containment measures.

PPE Provided by:    Permits Obtained by Contractor:

Clearance Testing Required:    Testing Method:

Clearing Laboratory / Provider:    Test Report #:

Clearance Result: Passed    Failed    Clearance Date:

WASTE HANDLING, DISPOSAL AND MANIFESTS

Contractor shall package, label, transport and dispose of contaminated materials in accordance with applicable law. Contractor will provide manifests and disposal receipts to Client upon completion.

Waste Manifest Number(s):

INSURANCE, INDEMNITY AND LIMITATION OF LIABILITY

Contractor shall maintain, at its expense, commercial general liability, workers’ compensation, automobile liability and pollution liability insurance in amounts customary for the industry. Proof of insurance and policy numbers shall be provided to Client upon request.

Insurance Policy Number(s):

Contractor agrees to indemnify, defend and hold harmless Client from and against claims, liabilities, damages and expenses arising out of Contractor’s negligence or willful misconduct in the performance of the work. Except for gross negligence or willful misconduct, Contractor’s aggregate liability shall be limited to the total Contract Price.

CERTIFICATION BY CONTRACTOR

Contractor certifies that the work performed under this Agreement has been completed in accordance with the Scope of Work, industry standards, and applicable law, and that all waste was handled and disposed of as required. Contractor will provide required documentation, manifests, and clearance reports to Client upon completion.

MISCELLANEOUS

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the state in which the Site is located, without regard to conflict-of-law principles.

Entire Agreement: This Agreement, including attachments and any referenced work authorizations, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, representations and agreements, whether written or oral. No amendment shall be effective unless in writing and signed by authorized representatives of both parties.

Assignment: Neither party may assign this Agreement without the prior written consent of the other, except that Contractor may assign to an affiliate or successor in interest in connection with a sale of substantially all of Contractor’s assets.

Site photos    Pre- or post-test reports    Permits and permits copies    Waste manifests

ACKNOWLEDGMENT

By signing below, the parties acknowledge that they have read, understand and agree to the terms of this Decontamination Service Agreement and Work Authorization and that the person signing on behalf of each party is duly authorized to execute this Agreement.

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