Prequalification Document

PREQUALIFICATION DOCUMENT

This Prequalification Document (the Agreement) is entered into as of Date: by and between Client Name: and Applicant Name: .

WHEREAS

WHEREAS, Client requires advance assessment and written confirmation of Applicant's qualifications, insurance, financial capacity, safety program and regulatory compliance prior to awarding work or authorizing site access; and

WHEREAS, Applicant represents that it possesses the experience, personnel, equipment and financial resources necessary to perform work within the scope described herein and agrees to provide accurate supporting documentation upon request; and

WHEREAS, the parties desire to set forth the terms under which Applicant is prequalified to bid or perform work for Client subject to the terms and conditions of this Agreement.

SCOPE OF WORK

Applicant describes the types of work for which it seeks prequalification and the limits of its capability. Applicant must provide a clear description of services, disciplines, and any limitations or exclusions below.

PAYMENT TERMS

Client's evaluation of Applicant does not constitute a commitment to purchase services. If and when work is authorized, payment terms shall be as provided in the applicable contract or purchase order. Applicant acknowledges the following standard payment parameters:

TERM AND TERMINATION

This prequalification remains in effect for the stated term unless earlier suspended or terminated in accordance with this section. Prequalification does not guarantee engagement.

Effective Start Date:    Effective End Date:

CONFIDENTIALITY

Applicant acknowledges that information provided to Client, including financial statements, safety records, personnel data and project-specific documents, may be confidential or proprietary. Applicant shall treat such information as confidential, shall not disclose it to third parties except as required by law, and shall use it only for the purpose of prequalification and related contracting activities. Applicant's obligation of confidentiality survives termination of this Agreement for a period of five (5) years.

Applicant acknowledges and certifies compliance with the confidentiality obligations: I acknowledge and agree.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state identified below, without regard to its conflict of law principles.

ENTIRE AGREEMENT

This document, together with any attachments, schedules and supporting documentation expressly referenced herein, constitutes the entire agreement with respect to prequalification and supersedes all prior oral and written representations and agreements. No amendment shall be binding unless in writing signed by authorized representatives of both parties.

APPLICANT INFORMATION

Corporation    LLC    Partnership    Sole Proprietor    Other

LICENSES, INSURANCE AND CERTIFICATIONS

Certificate of Insurance attached

REFERENCES

Provide three (3) recent project references for work similar in scope. Include company, contact, phone, job description and year completed.

SAFETY AND COMPLIANCE

FINANCIAL CAPACITY

ATTACHMENTS CHECKLIST

Applicant must attach or provide the following documents where applicable. Check all that are provided.

Financial statements (last 2 years)    Certificate of insurance    Copies of licenses    Project references    Safety program documentation

CERTIFICATION

By signing below, Applicant certifies under penalty of perjury that the information provided in this Prequalification Document and any attachments is true, complete and accurate to the best of Applicant's knowledge. Applicant authorizes Client to verify any information provided, including contacting references, insurers and financial institutions. Applicant agrees to notify Client promptly of any material change to the information provided.

Applicant acknowledges that Client may rely on the statements herein in determining Applicant's eligibility to bid or perform work, and that false or misleading information may result in disqualification or termination of any subsequent contract.

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