Specialty Services Application

SPECIALTY SERVICES APPLICATION

WHEREAS, Applicant Name: desires to obtain specialty services described herein; and

WHEREAS, Service Provider Name: represents that it is qualified and able to perform such services in accordance with the terms set forth below; and

WHEREAS, the parties intend by this application to document the requested scope, estimated budget, payment expectations and preliminary terms pending execution of a services agreement incorporating the provisions below.

Applicant Information

Requested Services

Select requested specialty services (check all that apply):

Consulting and advisory
Custom design and engineering
Installation or field services
Specialized testing or certification
Other (describe below)

Payment Terms

Estimated Total Budget: $

Deposit Required: — Payment Schedule:

Late Payment Fee: — Grace Period: days

All payments are due in lawful currency of the United States unless otherwise agreed in writing. Applicant acknowledges that Provider may suspend work for nonpayment after providing written notice and the opportunity to cure in accordance with the notice period below.

Term and Termination

Proposed Start Date: — Proposed End Date:

Either party may terminate any resulting services agreement for convenience upon days' prior written notice. Termination for cause (including material breach, nonpayment, or failure to cure) may occur immediately upon written notice if the breach is not cured within days after notice.

Confidentiality

The parties acknowledge that in the course of discussions and performance they may disclose confidential or proprietary information ("Confidential Information"). Each party agrees to maintain Confidential Information in strict confidence, to use it solely for the purposes of the requested services, and to disclose it only to those employees or contractors who have a need to know and who are bound by confidentiality obligations at least as protective as those contained herein.

Confidential Information does not include information that: (a) is or becomes publicly available other than through a breach of this provision; (b) is already known to the recipient at the time of disclosure as demonstrated by written records; or (c) is independently developed without use of Confidential Information. Upon termination or request, each party will return or destroy Confidential Information and certify such destruction upon reasonable request.

Applicant acknowledges and agrees to the confidentiality obligations above

Governing Law and Entire Agreement

Governing Law: This application and any subsequent services agreement shall be governed by the laws of the state or jurisdiction where Provider maintains its principal place of business, without regard to conflict of laws principles. The parties consent to the exclusive jurisdiction and venue of the state and federal courts located in that jurisdiction for any dispute arising out of or related to this application.

Entire Agreement: Applicant acknowledges that this Specialty Services Application, together with any executed services agreement and attachments, constitutes the entire understanding between the parties with respect to the subject matter herein and supersedes all prior negotiations and understandings. Any modification must be in a writing signed by authorized representatives of both parties.

Certifications and Authorizations

By signing below, Applicant certifies that the information provided in this application is true and accurate to the best of their knowledge, that Applicant has the authority to submit this application on behalf of the named organization, and that Applicant consents to Provider performing preliminary evaluations or limited preparatory work described herein in reliance on the representations and payment terms set forth above.

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