Elevators SignOff Form

ELEVATORS SIGNOFF FORM

Owner Name:    Contractor Name:

Project Name:    Project Address:

WHEREAS

WHEREAS, Owner retains Contractor to perform elevator installation, modernization, maintenance or testing services described in the Scope of Work below; and

WHEREAS, Contractor represents that all work performed and tests conducted comply with applicable building and elevator codes, applicable standards, and accepted industry practice, and that results documented on this signoff form reflect the condition of the equipment at the time of inspection; and

WHEREAS, the parties desire to evidence acceptance or conditional acceptance of the elevator work and to set payment, termination and related administrative provisions as set forth in this document.

SCOPE OF WORK

ELEVATOR DETAILS

Location in Building:    Capacity:

Passenger    Freight    Service/Hydraulic    Other:

INSPECTION CHECKLIST

Date of Inspection:    Inspector Name:    Inspector License/ID:

Operational test (run cycles)

Safety brake / governor test

Door and interlock operation

Emergency communication (phone/intercom)

Emergency lighting and alarm

Overload detection and signage

Pit and machine room condition

Accepted as Complete (no outstanding items)    Accepted with Punchlist (see Additional Deficiencies)    Rejected (work not accepted)

PAYMENT TERMS

Total Contract Amount: $

Late Payment Fee (if payment not made when due):    Payments due within days of invoice.

TERM AND TERMINATION

Term Start Date:    Term End Date:

Either party may terminate this agreement for cause upon written notice to the other party if the other party materially breaches any obligation and fails to cure within days. Termination without cause requires days' written notice.

CONFIDENTIALITY

Each party acknowledges that during the course of performance it may receive confidential information of the other party. Such information shall be used solely for the performance of this agreement and shall not be disclosed to third parties except as required by law. Confidential information shall remain confidential for from the date of disclosure.

GOVERNING LAW

This agreement shall be governed by and construed in accordance with the laws of the jurisdiction of: , without regard to conflict of laws principles.

ENTIRE AGREEMENT

This document, together with any exhibits and the Scope of Work described above, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior agreements and understandings, whether written or oral. No modification shall be effective unless in writing and signed by authorized representatives of both parties.

CONTRACTOR CERTIFICATION

Contractor certifies that all work performed has been completed in accordance with the Scope of Work, applicable codes and standards and that tests documented on this form were completed, signed by an authorized inspector, and that equipment is safe to place into service except for any deficiencies noted above.

Contractor Representative Name:    Title:

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