Property Wall Authorization Form

Property Wall Authorization Form

Property Address:    Parcel / APN:

Parties

Authorization Requested

Location on Property (select applicable): Interior Exterior Common Area

Painting / Coating    Drilling / Anchors    Signage / Mounting    Shelving / Brackets    Conduit / Electrical runs    Other:

Schedule, Contractor and Financial Terms

Requested Start Date:   Estimated Completion Date:

Contractor License Number:   General Liability Required:

Hazards, Disclosures and Permits

Lead-based paint known to exist? Yes No

Known mold or water damage affecting the work area? Yes No

Prior structural damage or repairs at location? Yes No

Permit Required? Yes No   Permit Number (if issued):

Insurance, Indemnity and Liability

The Requesting Party shall procure and maintain, at its sole cost, commercial general liability insurance with limits not less than the amount stated above and shall provide a certificate of insurance naming the Property Owner/Manager as an additional insured where required by the Owner. The Requesting Party shall indemnify and hold harmless the Owner from and against any and all claims, damages, liabilities, costs and expenses (including reasonable attorneys' fees) arising out of the work performed under this Authorization, except to the extent caused by the Owner's gross negligence or willful misconduct.

Does Requesting Party maintain workers' compensation coverage for all personnel performing the work? Yes No

Restoration, Inspection and Security

All penetrations, finishes and fastenings shall be restored to a condition at least equal to the original condition upon completion of the work unless otherwise agreed in writing. Requesting Party agrees to reimburse Owner for reasonable costs to repair unauthorized or defective work within 30 days of billing.

Inspection upon completion required by Owner? Yes No   Inspector Name:   Inspection Date:

Default, Revocation and Remedies

Authorization granted by this form may be revoked immediately by the Owner in the event of noncompliance with the terms herein, failure to obtain required permits, damage to property, or if the work creates a hazard. Upon revocation, Requesting Party shall promptly cease work and complete any required restoration. Owner's remedies for breach include, without limitation, requiring correction of the work, repairing at Requesting Party's expense, charging against any deposit, and pursuing all legal and equitable remedies.

Governing Law; Entire Agreement

This Authorization shall be governed by the laws of the state in which the Property is located. This document, together with any attachments and approved plans incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior agreements, understandings and representations.

Effective Period and Acknowledgments

Authorization Effective Date:    Authorization Expiration Date:

By signing below, the Requesting Party certifies that the information provided is true and that the work will be performed in accordance with all applicable laws, building codes and permit conditions. Requesting Party accepts responsibility for all costs, damages and liabilities arising from the work except those resulting from Owner's gross negligence or willful misconduct.

Additional Conditions / Owner Notes:

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