Legal Renewal Application

LEGAL RENEWAL APPLICATION

This Legal Renewal Application (the "Application") is submitted by Applicant Name: , whose principal address is Applicant Address: (Applicant), to Counterparty Name: , whose principal address is Counterparty Address: (Counterparty). This Application is made in connection with the renewal of the Original Agreement identified below.

RECITALS

WHEREAS, the parties entered into an agreement entitled Agreement Reference: originally effective as of Original Effective Date: ; and

WHEREAS, Applicant seeks to renew or extend the term, rights, or obligations under the Original Agreement as set forth in this Application; and

WHEREAS, Counterparty's consent may be required under the Original Agreement and these parties intend to document the requested renewal through this Application and any subsequent Renewal Instrument executed by the parties.

NOW, THEREFORE

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. RENEWAL REQUEST

1.1 Applicant requests renewal of the Original Agreement for the Renewal Term selected below and to incorporate any modifications described in Section 3. Renewal Term requested (select one):

One (1) Year Two (2) Years Other (specify):

1.2 Proposed Renewal Effective Date: . Proposed Renewal Term End Date (if applicable): .

2. APPLICANT REPRESENTATIONS AND WARRANTIES

Applicant represents and warrants that: (a) Applicant has full power and authority to submit this Application and to request the renewal described herein; (b) all information supplied in this Application and in any attachments is true, complete, and accurate as of the date of submission; and (c) there are no pending breaches, defaults, or claims against Applicant under the Original Agreement that would materially affect Counterparty's obligations or rights.

Applicant further certifies that any renewal documents prepared pursuant to this Application will not materially expand Applicant's obligations beyond the scope of the Original Agreement except as specifically described in Section 3 below.

3. PROPOSED MODIFICATIONS

3.1 Applicant shall attach or describe below any amendment, modification, or new terms proposed to be effective upon renewal. Describe material changes to rights, duties, pricing, or scope of the Original Agreement:

4. SUPPORTING DOCUMENTATION

Applicant must provide current copies of any documents relevant to the renewal. Indicate attachments submitted with this Application:

Proposed Amendment / Redline Certificate of Insurance Other (describe):

5. FEES AND PAYMENT

Applicant acknowledges payment of any administrative fees required for processing the Application. Fee Amount (if applicable): $. Payment Method: .

6. PROCESSING; ACCEPTANCE; EFFECTIVE DATE

6.1 Submission of this Application does not constitute approval. Counterparty shall review the Application and may request additional information or documentation. Approval is effective only upon execution of a written Renewal Instrument signed by authorized representatives of both parties.

6.2 Unless otherwise expressly agreed in writing, the Effective Date of any approved renewal shall be the date on which the last required signature is affixed to the Renewal Instrument.

7. CONFIDENTIALITY

Applicant acknowledges that information contained in this Application may be treated as confidential in accordance with the confidentiality provisions of the Original Agreement. Applicant consents to the use and limited disclosure of Application information to the extent necessary to evaluate and process the renewal.

8. INDEMNIFICATION

Applicant agrees to indemnify, defend and hold harmless Counterparty from and against any claims, liabilities, losses, costs, and expenses (including reasonable attorneys' fees) arising out of false statements, omissions, or misrepresentations in this Application or Applicant's failure to comply with its obligations under the Original Agreement or any Renewal Instrument.

9. NOTICES

All notices and communications related to this Application shall be delivered to the representatives identified below:

10. AMENDMENTS; WAIVER; COUNTERPARTS

No amendment to this Application shall be effective unless in writing and signed by authorized representatives of both parties. No waiver of any breach shall constitute a waiver of any subsequent breach. This Application and any Renewal Instrument may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument.

11. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Application shall be governed by and construed in accordance with the laws of the Governing State: , without regard to conflict of law principles. This Application, together with the Original Agreement and any subsequently executed Renewal Instrument, constitutes the entire agreement between the parties with respect to the subject matter hereof. If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

12. CERTIFICATION

By signing below, the undersigned certifies under penalty of perjury that the information contained in this Application and attachments is true and correct, that the signer is authorized to submit this Application on behalf of the named party, and that the party agrees to cooperate in good faith to execute any Renewal Instrument required to effectuate the requested renewal.

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