Facility Maintenance Request Form

FACILITY MAINTENANCE REQUEST FORM AND SERVICE AGREEMENT

WHEREAS, Requesting Party desires maintenance, repair, or preventive services for the facility specified below; and

WHEREAS, Service Provider represents that it is competent and qualified to perform the requested work in accordance with applicable codes, standards, and industry practice; and

WHEREAS, the parties intend for this document to serve both as a formal maintenance request and as the controlling agreement governing performance, payment, confidentiality, and termination for the services described herein.

Request Information

Request ID:     Date Requested:

Facility Location

Building:    Floor/Room:

Scope of Work

The Requesting Party requires the following scope of maintenance, repair, or services. Service Provider shall perform work in accordance with the scope described below and any attachments incorporated by reference.

Problem Description & Priority

Priority: Routine Urgent Emergency

Preferred Service Date:     Preferred Time Window:

Vendor / Contractor Information (if applicable)

Cost Estimate & Payment Terms

Estimated Cost:

Late Payment Fee:

Payment Terms (substantive): Service Provider shall invoice Requesting Party in accordance with the payment schedule above. Invoices are due in full within the payment term specified in the invoice. Late payments shall accrue the agreed late fee and may result in suspension of services following ten (10) days' written notice. Requesting Party reserves the right to withhold payment for defective or incomplete work until remedied in accordance with the scope and industry standards.

Term and Termination

Term Start Date:     Term End Date:

Notice Period for Termination:

Termination (substantive): Either party may terminate this agreement for cause upon material breach by the other party if the breach remains uncured thirty (30) days after written notice. Either party may terminate for convenience upon providing the notice period specified above. Upon termination, Service Provider shall be entitled to payment for work performed and documented costs incurred through the effective date of termination, less setoffs for defective or incomplete work.

Confidentiality

Each party shall maintain in confidence non-public information disclosed in connection with this request and any subsequent performance, and shall not disclose such confidential information to third parties except as necessary to perform obligations under this agreement or as required by law. Confidential information does not include information that is or becomes publicly available without breach of this agreement or that is independently developed by the receiving party. Obligations of confidentiality survive termination for a period of three (3) years.

Governing Law

This agreement shall be governed by and construed in accordance with the laws of the state or jurisdiction in which the facility is located, without regard to conflicts of law principles. The parties consent to the exclusive jurisdiction of the appropriate state or federal courts located in that jurisdiction for resolution of disputes arising under this agreement.

Entire Agreement

This document, together with any attachments or written change orders signed by both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, representations, or agreements, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

Approvals & Attachments

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