Jobsite Information Form

Jobsite Information Form and Service Agreement

Contractor Name:    Client Name:

This Jobsite Information Form and Service Agreement (the "Agreement") documents site-specific details, the scope of contracted services, and the administrative, safety and payment terms applicable to work to be performed by the Contractor at the jobsite identified below. The parties agree as set forth in the WHEREAS recitals and the clauses that follow.

WHEREAS

WHEREAS, Contractor is engaged in the business of providing construction, maintenance, installation, or related services and represents it has the experience, personnel, licenses and insurance necessary to perform the Work in a safe and professional manner; and

WHEREAS, Client owns or controls the jobsite described herein and desires to engage Contractor to perform the Scope of Work under the payment and scheduling terms set forth in this Agreement; and

WHEREAS, the parties desire to record site-specific conditions, access requirements, hazard information and administrative contacts to minimize risk and coordinate performance of the Work.

Jobsite Details

Access, Hours, and Parking

Regular access hours:    After-hours access required:

Site Conditions & Hazards

Known or suspected hazards (check all that apply):

Asbestos or ACM present     Confined spaces     Lead-based materials

Underground utilities     Overhead utilities     Scaffolding/working at height

Permits, Utilities & Insurance

Scope of Work

Payment Terms

Total Contract Amount: $

Late fee for past-due payments: . Client acknowledges timely payment is a condition of scheduling and continuation of Work.

Term and Termination

Work Start Date:    Expected Completion Date:

Either party may terminate this Agreement for convenience upon written notice to the other party delivered not less than days prior to the intended termination date. Termination for cause may be immediate where a material breach presents an imminent safety hazard or where a party fails to cure a material breach within ten (10) days of written notice, unless a different cure period is required by law.

Confidentiality

Each party will keep confidential all nonpublic commercial, technical, safety or security information of the other party that is marked confidential or would reasonably be understood to be confidential given the nature of the information and circumstances of disclosure. Confidential information shall not include information that is publicly available, independently developed, or rightfully obtained from a third party. This obligation survives termination of this Agreement 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 of , without regard to its conflict of law principles.

Representations and Warranties; Safety

Contractor represents that it maintains all required licenses, permits and insurance for performance of the Work and will comply with applicable safety laws, codes and site rules. Client represents that it has disclosed known site hazards and will coordinate access to utilities and permits as required. Each party agrees to promptly notify the other of any condition that poses a material safety risk.

Entire Agreement

This Agreement, together with any attachments or change orders executed by the parties, constitutes the entire agreement between the parties regarding the subject matter herein and supersedes all prior negotiations, proposals and representations, whether written or oral. No amendment is effective unless in writing and signed by both parties.

Acknowledgement

By signing below, the undersigned representatives certify that they are authorized to bind their respective parties, that the information provided in this Jobsite Information Form is accurate to the best of their knowledge, and that the parties agree to the terms set forth in this Agreement.

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