Equipment Removal Authorization Form

Equipment Removal Authorization Form

WHEREAS

WHEREAS, Authorizing Party: , whose address is , is the owner or lawful custodian of equipment listed below;

WHEREAS, Contractor: , whose contact address is , is engaged to remove such equipment from the Premises located at .

WHEREAS, Owner desires Contractor to remove certain equipment in accordance with the terms and conditions set forth herein.

SCOPE OF WORK

EQUIPMENT INVENTORY

List all equipment to be removed. Include sufficient detail to identify each item.

REMOVAL DETAILS

Scheduled Removal Date:   Scheduled Start Time:

On-site pickup Crane / hoist Flatbed transport Partial dismantle

Are any permits required? Yes No   If yes, Permit/Reference No.:

PAYMENT TERMS

Total Contract Amount: $ .

Deposit: due upon execution.   Balance due:

Late Payment Fee: . Payments remain the responsibility of Authorizing Party until collection.

Payment Method: .

TERM AND TERMINATION

Term Commencement Date: .   Term Expiration Date: .

Either party may terminate this Agreement for convenience upon written notice delivered not less than prior to the intended termination date. Termination for cause may be immediate where a material breach is not cured within 10 business days of written notice.

CONFIDENTIALITY

Each party shall maintain in confidence all confidential information disclosed by the other party in connection with this Agreement, shall not disclose such information to any third party except as required by law or to perform obligations under this Agreement, and shall use at least the same degree of care as it uses to protect its own confidential information but in no event less than reasonable care.

INSURANCE AND INDEMNITY

Contractor shall maintain commercial general liability and workers' compensation insurance with limits sufficient for the Work and shall provide proof of insurance upon request. Contractor shall indemnify, defend and hold harmless Authorizing Party from and against claims, liabilities, losses and expenses arising from Contractor's negligent acts or omissions in the performance of the removal, except to the extent caused by Authorizing Party's gross negligence or willful misconduct.

Insurance Provider:   Policy Number:

REPRESENTATIONS AND WARRANTIES

Authorizing Party represents and warrants that it is the owner or has full authority to authorize removal of the listed equipment, that the equipment is free of undisclosed liens or encumbrances, and that performance of the removal will not violate any agreement with third parties. Authorizing Party shall indemnify Contractor for claims arising from breach of these representations.

GOVERNING LAW

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

ENTIRE AGREEMENT

This Agreement, including attachments and listed equipment, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals and understandings, whether written or oral. Any modification must be in writing and signed by both parties.

OWNER AUTHORIZATION AND CERTIFICATION

By signing below, Authorizing Party certifies that the information in this form is true and correct, that they have the authority to grant removal rights for the equipment described, and that they authorize Contractor to access the Premises and remove the equipment in accordance with this Agreement. Authorizing Party releases Contractor from liability for pre-existing defects in the equipment and for any incidental damage to non-listed items caused by reasonable removal activities, except where caused by Contractor's gross negligence or willful misconduct.

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