Legal Submission Part B

LEGAL SUBMISSION PART B

This Legal Submission Part B is submitted by Client Name: and delivered to Respondent Name: pursuant to Submission Reference No.: , effective Date: .

RECITALS

WHEREAS, Client Name has previously submitted a primary submission identified as Part A and seeks to supplement, clarify, or provide additional factual material and certifications in this Part B;

WHEREAS, Respondent Name requires supplemental documentation, factual statements, and authorized certifications as a condition to further administrative or contractual processing; and

WHEREAS, the parties intend that this Part B be incorporated into the overall submission record and that the representations and certifications herein be relied upon by the receiving party for the purposes set forth in the Submission Reference No. field above;

NOW, THEREFORE, in consideration of the mutual covenants and agreements set forth in this Legal Submission Part B, the parties agree as follows:

1. DEFINITIONS

In this Submission, the following terms shall have the meanings ascribed to them: "Part A" means the original submission referenced above; "Submission Record" means the whole file comprised of Part A, this Part B, and any attached exhibits; "Authorized Representative" means an individual with actual authority to bind the submitting party as evidenced by corporate resolution, power of attorney, or similar instrument.

2. SCOPE OF SUBMISSION

2.1 The Client Name submits the factual statement and supporting materials described in this Part B for inclusion in the Submission Record. The materials submitted herewith constitute supplemental factual information and certifications and are intended to be read together with Part A.

2.2 The Client Name warrants that all documents, statements, and other materials attached or described in this Part B are authentic, complete, and have not been altered in a manner that would render them misleading.

3. REPRESENTATIONS AND WARRANTIES

3.1 Each party represents and warrants to the other that: (a) it has full corporate or legal power and authority to execute and deliver this Part B and to perform its obligations hereunder; (b) the individual signing this Part B is an Authorized Representative duly empowered to bind the signing party; (c) the execution and performance of this Part B will not violate any law, contractual obligation, or court or administrative order to which such party is subject.

3.2 The Client Name further represents that, to the best of its knowledge after due inquiry, the facts stated in the Submission Summary are true and complete in all material respects and that no material fact has been omitted that would render the submission misleading.

4. CERTIFICATIONS AND ACKNOWLEDGEMENTS

4.1 The Authorized Representative of the Client Name certifies, under penalty of perjury where applicable, that the information provided in this Part B and any attachments is true, accurate, and complete to the best of the representative's knowledge and belief.

4.2 The Client Name acknowledges that knowingly submitting false information may give rise to administrative, civil, or criminal penalties and may be grounds for rejection or adverse action on the Submission Record.

Exhibit A — Documentary evidence or records

Exhibit B — Redacted or confidential version (if applicable)

Other attachments — provide description below

5. CONFIDENTIALITY

5.1 Except as otherwise required by law or order of a competent tribunal, each receiving party shall treat as confidential all non-public portions of the Submission Record designated in writing as confidential by the submitting party at the time of submission, and shall not disclose such information to any third party except as necessary to fulfill its official duties and only under written obligations of confidentiality.

5.2 Confidential treatment shall not apply to information that: (a) is or becomes public through no wrongful act of the receiving party; (b) is lawfully received from a third party without restriction; or (c) is independently developed by the receiving party without reference to the confidential material.

6. RECORDS RETENTION AND AUDIT

6.1 The Client Name shall retain all original documents and records underlying the submissions for a period of no less than three (3) years from the date of this Part B, or for such longer period as may be required by applicable law. The Respondent Name reserves the right to request and review originals subject to reasonable notice and protection of privileged or confidential material.

7. NOTICES

All notices, requests, demands, and other communications required or permitted under this Part B shall be given in writing and delivered to the addresses set forth below, and shall be deemed duly given upon receipt.

8. AMENDMENT; WAIVER

8.1 This Part B may be amended only by a written instrument executed by both parties. No failure or delay by either party in exercising any right, power, or privilege under this Part B shall operate as a waiver thereof, nor shall any single or partial exercise preclude any other or further exercise of any right.

9. GOVERNING LAW

This Part B shall be governed by and construed in accordance with the substantive laws of the jurisdiction identified below without regard to conflict of laws principles. The parties submit to the exclusive jurisdiction of the courts of the chosen jurisdiction for purposes of any dispute hereunder.

10. ENTIRE AGREEMENT

This Part B, together with Part A and any referenced exhibits, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations, and discussions, whether oral or written.

11. SEVERABILITY

If any provision of this Part B is held invalid, illegal, or unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect and be construed so as to best effectuate the intentions of the parties.

12. COUNTERPARTS

This Part B 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. Signatures transmitted by facsimile, electronic image, or other electronic means shall be deemed original signatures for all purposes.

Sign Now