Pre-Approval Submission Form

Pre-Approval Submission Form

Parties and Submission Details

Recitals

WHEREAS, Applicant seeks pre-approval from Approving Entity for the proposed project or action described in this submission and requires a written determination prior to committing to expenditures or contractual obligations;

WHEREAS, Approving Entity has authority to grant conditional or unconditional pre-approval subject to review of documentation, compliance with applicable standards, and the terms set forth in this form and any attached exhibits; and

WHEREAS, the parties intend that issuance of a pre-approval shall be governed by the terms of this agreement between Applicant and Approving Entity and shall define the obligations of each party with respect to the pre-approved activity.

Project / Request Summary

Proposed Start Date:     Proposed End Date:

Scope of Work / Description

Supporting Documents Checklist

Provide copies of the following as part of this submission (check all that apply): Site plans / drawings Technical specifications / scope Budget / cost estimates Insurance certificates Other (describe below)

Payment Terms

Applicant acknowledges responsibility for payment of any fees associated with review or issuance of the pre-approval per the schedule below. Fees must be paid in accordance with the payment schedule and prior to final issuance where required.

Late Fee: Applicant agrees that unpaid amounts shall accrue interest at a rate of and that Approving Entity may suspend pre-approval processing until outstanding fees are paid.

Term and Termination

The pre-approval, if granted, shall be effective as of the effective date set forth below and shall expire on the expiration date unless earlier terminated in accordance with this section. Approving Entity may revoke or conditionally modify any pre-approval based on material changes to the proposed scope or noncompliance with conditions.

Effective Date:    Expiration Date:

Confidentiality

All information submitted in connection with this pre-approval request shall be treated as confidential to the extent permitted by law. Approving Entity shall not disclose proprietary technical, financial, or business information of Applicant to third parties except as required by law or to employees, consultants, and contractors with a need to know who are bound by confidentiality obligations no less protective than those set forth herein.

Confidential information does not include information that: (a) is or becomes publicly available through no breach by Approving Entity; (b) is lawfully received from a third party without restriction; or (c) is independently developed by Approving Entity without use of Applicant's confidential information.

Governing Law; Compliance

This agreement and any pre-approval issued hereunder shall be governed by and construed in accordance with the laws of the state of without regard to conflicts of law principles. Applicant shall comply with all applicable laws, regulations, codes, and permitting obligations in conducting the pre-approved activity.

Representations, Warranties and Indemnity

Applicant represents and warrants that the information provided in this submission is true and complete to the best of Applicant's knowledge. Applicant shall indemnify, defend and hold harmless Approving Entity from and against any claims, liabilities, costs, or damages arising from Applicant's breach of this submission, negligent acts, or willful misconduct in connection with the pre-approved activity.

Entire Agreement

This Pre-Approval Submission Form, together with any attachments and any written pre-approval issued by Approving Entity, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, representations, and agreements, whether written or oral. Any modification to these terms must be in writing and signed by both parties.

Administrative Certifications

By signing below, Applicant certifies that the information contained in this submission is accurate to the best of Applicant's knowledge and that Applicant has authority to request pre-approval on behalf of the Applicant.

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