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Legal PFAS Declaration Form

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LEGAL PFAS DECLARATION FORM

This Legal PFAS Declaration Form (this "Declaration") is made and entered into as of , by and between Client Name: and Supplier Name: .

RECITALS

WHEREAS, Client purchases, specifies or otherwise uses products, components or materials supplied by Supplier for use in Client's goods or operations, and Client requires certain assurances regarding the presence, testing and disclosure of per- and polyfluoroalkyl substances ("PFAS");

WHEREAS, Supplier manufactures, supplies or distributes the products described in this Declaration and is able to test for, disclose and certify the presence or absence of PFAS in those products, and to maintain records of such testing; and

WHEREAS, the parties desire to document Supplier's representations, testing protocols, notification obligations and remedies relating to PFAS content in the products supplied to Client.

NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth below, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this Declaration, the following definitions apply:

"PFAS" means per- and polyfluoroalkyl substances, including but not limited to long-chain and short-chain PFAS, their precursors and degradation products as identified by recognized analytical methods.

"Threshold" means the maximum total concentration of PFAS in a product above which Supplier's disclosure obligations and Client's remedies under this Declaration are triggered. Threshold:

2. DECLARATION, REPRESENTATIONS AND WARRANTIES

Supplier hereby represents and warrants to Client that, as of the Effective Date and with respect to the products supplied to Client described below, Supplier's statements concerning PFAS are true, accurate and complete to the best of Supplier's knowledge after reasonable inquiry:

Supplier certifies (check all applicable):

PFAS are not intentionally added during the manufacture of the above-referenced products and Supplier has processes in place to prevent intentional addition.

PFAS are present only at concentrations below the Threshold specified above, based on testing described below.

PFAS are present at or above the Threshold. If checked, Supplier shall provide the information required in Section 2.1 and the remediation obligations set forth in Section 4 shall apply.

2.1 TESTING AND DISCLOSURE

3. RECORDS, AUDIT AND RETENTION

Supplier shall retain records of all test results, certificates, material specifications and supplier qualifications relating to PFAS for a period of years following delivery of the applicable products. Upon reasonable written request, Supplier shall provide copies of such records to Client within a commercially reasonable time.

4. NOTIFICATION, REMEDIATION AND REMEDIES

Supplier shall notify Client in writing within calendar days after discovering any test result, complaint, or incident indicating the presence of PFAS at or above the Threshold. Notification shall include all known test results, affected lot numbers and proposed remedial actions.

If PFAS are detected at or above the Threshold, Supplier shall, at Supplier's expense, promptly undertake corrective action reasonably acceptable to Client, which may include product recall, replacement, remediation of affected materials, reimbursement of Client's reasonable costs, and any other equitable relief as necessary to mitigate risk.

5. INDEMNIFICATION

Supplier shall indemnify, defend and hold harmless Client and its officers, directors, employees and affiliates from and against any and all claims, liabilities, losses, damages, fines, penalties, and reasonable costs and expenses (including attorneys' fees) arising out of or related to Supplier's breach of this Declaration, negligent misrepresentation regarding PFAS, or the presence of PFAS in products supplied by Supplier in excess of the Threshold.

6. LIMITATION OF LIABILITY

EXCEPT FOR LIABILITY ARISING FROM SUPPLIER'S FRAUD, WILLFUL MISCONDUCT, OR ITS INDEMNIFICATION OBLIGATIONS UNDER SECTION 5, NEITHER PARTY SHALL BE LIABLE TO THE OTHER FOR ANY CONSEQUENTIAL, INCIDENTAL, EXEMPLARY, OR PUNITIVE DAMAGES ARISING FROM OR RELATED TO THIS DECLARATION.

7. TERM, TERMINATION AND REMEDIES

This Declaration shall remain effective for as long as Supplier supplies the products described herein to Client or until otherwise terminated by mutual written agreement. Client may terminate any purchase relationship for cause if Supplier fails to comply with its obligations under this Declaration and fails to cure within thirty (30) days after written notice of breach.

8. CONFIDENTIALITY

Except as required by law or regulation, neither party shall disclose the other party's confidential information, including analytical reports, test methods and proprietary formulations, without prior written consent. Notwithstanding the foregoing, Supplier may disclose testing information to regulatory authorities as required by applicable law, provided Supplier gives Client prior written notice of such disclosure to the extent permitted.

9. NOTICES

10. GOVERNING LAW, SEVERABILITY AND MISCELLANEOUS

This Declaration shall be governed by and construed in accordance with the laws of the State of without regard to conflict of laws principles.

Entire Agreement: This Declaration, together with any purchase orders or written attachments expressly incorporated by reference, constitutes the entire agreement between the parties with respect to PFAS declarations and supersedes all prior or contemporaneous representations and agreements, whether written or oral, relating to PFAS.

Severability: If any provision of this Declaration is held to be invalid or unenforceable, the remainder of this Declaration shall remain in full force and effect and such provision shall be reformed only to the extent necessary to make it valid and enforceable.

Amendments and Waiver: No amendment, modification or waiver of any provision of this Declaration shall be valid unless in writing signed by both parties. No failure or delay by either party in exercising any right shall operate as a waiver of that right.

Counterparts: This Declaration may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Electronic signatures and scanned copies of executed counterparts shall be binding.

Client:

By:

Date:

Supplier:

By:

Date:

Enter text✕

What the Legal PFAS Declaration Form Is

The Legal PFAS Declaration Form is a standardized written statement used by manufacturers, suppliers, contractors, or facility operators to disclose the presence, absence, or concentration of per- and polyfluoroalkyl substances (PFAS) in products, materials, or waste streams. The form documents factual information and supporting data, records who prepared the declaration, and establishes a date of attestation. It is commonly used for contract compliance, procurement due diligence, environmental reporting, and regulatory submissions where parties require a formal, signed representation about PFAS status.

Why a Formal PFAS Declaration Matters

A clear Legal PFAS Declaration Form reduces ambiguity in contracts, supports regulatory compliance, and creates an auditable record of representations about PFAS. Properly completed forms protect buyers and sellers by documenting facts, the preparer’s authority, and the effective date of the attestation.

Why a Formal PFAS Declaration Matters

Who Typically Completes or Requests This Form

Common users include procurement teams, environmental compliance officers, and legal counsel involved in supply-chain and product safety reviews.

  • Procurement officers and buyers requesting PFAS status as part of vendor prequalification and contract award checks.
  • Environmental, health and safety managers providing laboratory results, sampling methods, and technical attestations.
  • Legal and compliance teams reviewing declarations for contract warranties, indemnities, and regulatory risk allocation.

Knowing which role completes each section helps assign responsibility and reduces processing delays during contract execution and regulatory checks.

Typical Signatories and Record Holders

Environmental Compliance Manager

The Environmental Compliance Manager prepares or reviews technical sections, signs attestations on behalf of the company, and retains supporting lab reports and chain-of-custody records for regulatory or audit purposes.

Authorized Officer

A corporate officer or delegated signatory with authority to make legal representations signs the declaration block, confirms accuracy under penalty of law or contract, and ensures preservation of the record.

Core Components of a Professional PFAS Declaration

A complete Legal PFAS Declaration Form balances concise factual fields with attachments for technical data. The following elements form the baseline for enforceable and defensible declarations.

Declarant Identity

Full legal name, title, company, and contact details for the person making the statement, so attribution and follow-up are clear and auditable.

Scope Description

Precise description of products, materials, lot numbers, or processes covered by the declaration to avoid overbroad or ambiguous representations.

PFAS Status

Clear statement: 'no detectable PFAS', 'contains PFAS', or 'PFAS not analyzed', with defined detection limits and test methods.

Supporting Data

Attach laboratory certificates, chain-of-custody forms, sampling dates, and methods (e.g., EPA method) used to arrive at the stated PFAS status.

Legal Attestation

Signed declaration language indicating the signer's authority and that the information is true to the best of their knowledge under penalty of applicable law or contract.

Effective Date

Date the declaration is made and any limited validity period for the statement, which helps buyers manage re-testing or re-certification timelines.

Required Fields at a Glance

Declarant Name: Full legal name
Company: Legal entity name
Product Scope: SKU or lot
PFAS Statement: Presence/absence
Test Method: Method name
Signature Date: MM/DD/YYYY

Step-by-step: Completing the PFAS Declaration

Follow these steps to prepare, verify, and sign a clear and legally defensible declaration.

  • 01
    Identify scope: List specific products, lots, or processes covered.
  • 02
    Attach data: Include lab reports and chain-of-custody records.
  • 03
    Confirm authority: Ensure the signer has corporate signing power.
  • 04
    Sign and date: Execute signature and enter MM/DD/YYYY.

How to Configure an Online Declaration Workflow

Configure digital fields and authentication to match your compliance and audit needs.

Field Configuration
Authentication method Email link or SMS code
Conditional fields Show lab attachments when 'Contains PFAS' selected
Audit trail Capture IP, timestamp, and actions
Template reuse Save as template for consistent use

Delivery Channels and Integration Options

The form can be shared via email, signing links, APIs, or integrated systems to fit procurement and compliance workflows.

  • Email or Link: Simple distribution and signing
  • API Integration: Automates embed and storage
  • Third-party apps: Connects with common CRMs

Typical eSubmission Flow for a PFAS Declaration

A standard eSubmission path ensures consistent capture of evidence and signer identity for future audits.

  • Upload document: Add form and attach lab reports
  • Place fields: Add signature, date, and checklist fields
  • Send to signer: Use authenticated email or SMS
  • Capture audit: Store signed PDF and audit log

Electronic vs Digital Signatures: Key Differences

Choose the appropriate signature type for evidence strength, regulatory requirements, and non-repudiation needs.

Criteria Electronic Signature Digital Signature
Definition any electronic mark pki-based cryptographic
Legal acceptance esign/ueta accepted esign/ueta accepted
Non-repudiation audit trail based certificate-based strong
Typical use cases contracts, disclosures high-assurance regulated filings

Comparing eSignature Providers for PFAS Declarations

Cost, compliance features, and envelope limits affect which provider fits high-volume PFAS declaration workflows; signNow is listed first for direct feature comparison.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial, no credit card required No No Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Penalties and Legal Risks of Incorrect Declarations

Civil Fines: Administrative fines and penalties
Contract Breach: Contract termination or damages
Criminal Liability: Possible for intentional false statements
Product Recall: Costs and logistical liabilities
Regulatory Action: Enforcement orders or notices
Reputational Harm: Loss of customers or contracts

Common Preparation Errors to Avoid

  • Missing or incomplete lab reports that lack detection limits and method documentation cause disputes over the declaration’s reliability.
  • Using vague scope language such as 'all products' rather than listing SKUs or lot numbers leads to unintended coverage.
  • Having an unauthorized signer execute the form can void contractual warranties and require re-execution.
  • Failing to retain chain-of-custody records or original test certificates undermines defensibility in audits or litigation.

Practical Use Cases and Outcomes

Realistic scenarios illustrate how declarations are used across procurement, manufacturing, and environmental compliance workflows.

Supplier Prequalification

A supplier provides a PFAS declaration for specific SKUs

  • Buyer requests attached lab report showing 'No Detect' at stated limits
  • The buyer accepted the supplier and avoided costly retesting by verifying documentation and signer authority.

Contract Award Condition

A contractor attests to PFAS absence in protective coatings

  • Procurement conditions payment on periodic verification
  • The contractor established recurring testing and retained records to satisfy both contract and regulatory audits.

Download, Storage, and Supporting Documents

Provide guidance on export formats and what supporting documents to attach when saving or sharing the signed declaration.

PDF Signed Copy

Save a final signed PDF/A copy including embedded audit trail and attachments to preserve integrity and long-term readability.

Lab Certificates

Attach accredited laboratory results and chain-of-custody forms as separate PDFs or combined with the declaration.

Contract Exhibit

Include the declaration as an exhibit to procurement contracts to make representations and warranties explicit.

Internal Record

Store a copy in contract management and document repositories with access controls and retention metadata.

Practical Tips for Accurate and Efficient Declarations

Follow these practices to reduce rework, support compliance, and create audit-ready records.

Standardize form templates
Use a consistent template with mandatory fields, dropdowns for status, and conditional attachments so reviewers see complete declarations the first time.
Require authoritative signers
Designate specific job titles or officers who may sign declarations; maintain a roster of delegated signatories and documentation of their authority.
Attach objective evidence
Always include lab methods, detection limits, lab accreditation, and chain-of-custody to substantiate analytic results and avoid technical disputes.
Preserve audit trails
Retain signed PDFs and detailed audit logs (timestamp, IP, signer identity) to meet ESIGN/UETA retention and evidentiary needs.

Typical Timelines, Deadlines, and Processing Expectations

Understand common timing triggers so the declaration is prepared and validated when needed for contracts or reporting.

Supplier request response:

Complete and return within contract timeframe, often 5–15 business days

Contract award condition:

Declaration due before first shipment or initial payment

Regulatory reporting:

Deadlines vary by agency; confirm per-state or federal reporting rules

Re-testing cadence:

Establish validity period (e.g., 12 months) or event-driven re-testing

Record retrieval:

Allow up to 30 days for retrieval from archives or legal holds

Frequently Asked Questions

Answers to common questions about legal validity, e-signing, notarization, and recordkeeping for a Legal PFAS Declaration Form.


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