On Site Work Authorization Form

ON SITE WORK AUTHORIZATION FORM

RECITALS

WHEREAS Client Name: and Contractor Name: (collectively, the Parties) desire to document authorization for on-site work at the location identified below.

WHEREAS the Parties wish to set forth the scope, schedule, payment terms, safety and insurance requirements, and other terms governing Contractor's performance of on-site services at the Site Address:

WHEREAS the Parties intend this form to constitute a binding authorization and agreement governing the described on-site work.

PARTIES AND CONTACTS

SCOPE OF WORK

The Contractor is authorized to perform the following work at the Site. All work shall conform to accepted industry standards and applicable law.

SITE ACCESS, SAFETY & PERMITS

The Contractor shall comply with all site safety rules and shall at all times follow Client's reasonable safety directives. The Client grants Contractor reasonable access during the hours: .

Permits required: Yes    |    Contractor to obtain permits: Yes

Known site hazards or access restrictions (describe):

PAYMENT TERMS

Total Authorized Amount: $

Late fee for overdue amounts:    (applies per month on outstanding balance unless otherwise agreed in writing)

Accepted payment methods: Check Card Wire Transfer

TERM AND TERMINATION

Term Commencement Date:    Termination / Estimated Completion Date:

Either Party may terminate this authorization for convenience upon written notice to the other Party with at least days' prior notice. Termination for material breach is permitted if the breaching Party fails to cure within days after written notice.

INSURANCE, INDEMNITY & COMPLIANCE

Contractor shall maintain commercial general liability insurance and workers' compensation as required by applicable law and shall provide proof of insurance upon request. Insurance Carrier:

Policy Number:    Certificate required to Client: Yes

Contractor shall indemnify and hold Client harmless from claims, liabilities, losses, and expenses arising from Contractor's performance, except to the extent caused by Client's negligence or willful misconduct.

Contractor will comply with all applicable laws, codes, ordinances, and regulations and will ensure that personnel are trained and supervised consistent with safety requirements. Client retains stop-work authority where unsafe conditions are observed; Contractor shall promptly cure identified hazards.

CONFIDENTIALITY

Each Party shall keep confidential information obtained from the other Party in connection with this authorization and shall not disclose such information except (i) to its employees, agents or contractors who have a need to know and are under comparable confidentiality obligations, (ii) as required by law, or (iii) with the disclosing Party's prior written consent. Confidential materials shall be returned or destroyed upon reasonable request.

GOVERNING LAW & ENTIRE AGREEMENT

This authorization and any dispute arising out of it shall be governed by the laws of the state in which the Site is located, without regard to principles of conflicts of law. The Parties consent to the exclusive jurisdiction of the courts competent in that state for resolution of disputes.

This document constitutes the entire agreement between the Parties with respect to the subject matter herein and supersedes all prior negotiations, representations, and agreements, whether written or oral. Any amendment must be in writing and signed by both Parties.

ACKNOWLEDGMENT

By signing below, each Party certifies that the person signing on its behalf is authorized to bind that Party to the terms of this On Site Work Authorization Form and that such Party accepts the obligations set forth herein.

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