Legal Community Disclosure Form

LEGAL COMMUNITY DISCLOSURE FORM

This Legal Community Disclosure Form is made effective as of Date: by and between Disclosing Party: , and Receiving Party: .

RECITALS

WHEREAS, Disclosing Party maintains relationships, affiliations, activities and financial interests within the legal and civic community that may be material to matters on which the Receiving Party provides services; and

WHEREAS, the Parties desire to record and make ongoing disclosure of such community relationships and potential conflicts to facilitate ethical compliance, informed engagement, and proper management of potential conflicts of interest; and

WHEREAS, the Parties intend that disclosures made under this Form be relied upon for the purpose of evaluation of conflicts, recusal determinations, and the reasonable administration of legal and professional obligations.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the Parties agree as follows:

1. DEFINITIONS

In this Form, unless the context requires otherwise: (a) "Community Relationship" means any financial interest, employment, board membership, volunteer role, political activity, gift, familial relationship, or other affiliation with a third party that could reasonably be construed to affect independence, objectivity, or duties; and (b) "Confidential Information" means nonpublic information disclosed under Section 4 and designated as confidential or that reasonably should be understood to be confidential given the nature of the information and the circumstances of disclosure.

2. DISCLOSURE OF COMMUNITY RELATIONSHIPS

Disclosing Party hereby discloses the following categories of community relationships that exist as of the effective date and which may be material to work performed by Receiving Party. The Disclosing Party shall identify particular persons, entities, and descriptions in the Detailed Disclosure field below.

3. ONGOING DUTY TO UPDATE

Disclosing Party represents and warrants that it will update the disclosures required by this Form promptly upon acquiring material information not disclosed herein. Updates shall be provided in writing within days of the date the Disclosing Party becomes aware of the material change.

4. USE AND CONFIDENTIALITY

Unless otherwise agreed in writing, disclosures made under this Form shall be used solely for the purpose of evaluating conflicts and administering professional responsibilities. Receiving Party shall treat disclosed information as Confidential Information to the extent permitted by applicable professional rules and shall restrict access to those employees, partners or advisors with a need to know.

Notwithstanding the foregoing, Receiving Party may disclose information as required by law, court order, professional disciplinary process, or to its legal counsel; provided that Receiving Party gives Disclosing Party prompt written notice of such required disclosure to the extent permitted.

5. CONFLICTS RESOLUTION

If a disclosed relationship gives rise to a potential conflict of interest, the Parties shall cooperate in good faith to adopt reasonable measures, which may include screening, consent, recusal, or withdrawal, to address the conflict while protecting client interests and complying with applicable professional obligations.

6. REPRESENTATIONS AND WARRANTIES

Each Party represents and warrants that: (a) it has the full power and authority to execute and deliver this Form and to perform its obligations; (b) the information disclosed on this Form is true and correct to the best of the disclosing Party's knowledge as of the date signed; and (c) any material change will be promptly disclosed pursuant to Section 3.

7. INDEMNIFICATION

Each Party shall indemnify, defend and hold harmless the other Party from and against any losses, claims, liabilities, damages, and expenses (including reasonable attorneys' fees) arising from any material misrepresentation or breach of this Form by the indemnifying Party, except to the extent such losses result from the indemnitee's gross negligence or willful misconduct.

8. NOTICES

All notices and other communications under this Form shall be in writing and shall be delivered to the addresses specified below by hand, nationally recognized overnight courier, certified mail (return receipt requested), or electronic mail with confirmation of delivery where agreed in writing.

9. AMENDMENTS; WAIVER; COUNTERPARTS

This Form may be amended only by a written instrument executed by both Parties. No failure or delay in exercising any right will operate as a waiver, and no single or partial exercise of any right will preclude further exercise. This Form may be executed in counterparts, each of which shall be deemed an original and all of which shall constitute one and the same instrument.

10. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Form shall be governed by and construed in accordance with the laws of the state of , without regard to conflict of laws principles. This Form contains the entire agreement of the Parties with respect to its subject matter and supersedes all prior and contemporaneous agreements and understandings, whether written or oral. If any provision of this Form is held invalid or unenforceable, the remaining provisions will remain in full force and effect.

11. MISCELLANEOUS PROVISIONS

The Parties acknowledge that disclosures made hereunder may be relied upon by other related entities or partners where relevant, and each Party will take reasonable steps to ensure that its agents and representatives comply with the terms of this Form. Any party providing information warrants that such information is provided in good faith.

Certification: By signing below, each signatory certifies under penalty of perjury that the information provided in this Form is true, complete and correct to the best of the signatory's knowledge and that the signatory is authorized to make the disclosures and execute this Form on behalf of the identified Party.

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