Supplier Compliance Declaration Form

SUPPLIER COMPLIANCE DECLARATION FORM

WHEREAS

WHEREAS, Supplier Name: is engaged to provide goods and/or services to Buyer Name: under the terms of a commercial relationship effective as of Effective Date: .

WHEREAS, Buyer requires as a condition of contracting that Supplier represent, warrant and covenant compliance with applicable law, buyer policies and industry standards as set forth in this Supplier Compliance Declaration.

SUPPLIER INFORMATION

SCOPE OF WORK

Describe the goods and/or services to be provided pursuant to the applicable purchase order, contract or engagement. Include deliverables, performance standards, and any material specifications.

COMPLIANCE DECLARATIONS

The Supplier hereby certifies, represents and warrants to Buyer that, as of the date of signature below, the following statements are true and accurate. Supplier must check each applicable box to indicate compliance.

Supplier complies with all applicable laws, regulations and permits relevant to the performance of the scope of work, including but not limited to labor, tax, environmental and health and safety laws.

Supplier maintains policies and procedures prohibiting bribery, facilitation payments and corrupt practices and has not been convicted of or subject to enforcement action for such conduct.

Supplier adheres to applicable wage and hour laws, prohibits forced labor and child labor, and provides safe working conditions consistent with accepted labor standards.

Supplier will use commercially reasonable efforts to ensure materials supplied do not originate from conflict-affected regions and will comply with applicable environmental statutes and regulations.

Supplier will handle Buyer data in accordance with applicable data protection laws and will implement appropriate technical and organizational measures to protect confidential information.

Supplier will ensure that any subcontractor or third party engaged to perform obligations under the scope of work are bound by equivalent compliance obligations.

Supplier maintains insurance coverage appropriate to the services and will provide certificates of insurance upon request.

AUDIT RIGHTS AND RECORDS

Supplier acknowledges Buyer (or its authorized representative) may, upon reasonable notice, audit Supplier's records, facilities and systems as reasonably necessary to verify compliance with this Declaration. Supplier will retain records relevant to performance and compliance for a period of at least from the date of final delivery.

PAYMENT TERMS

Unless otherwise agreed in a separate contract or purchase order, Buyer agrees to pay Supplier the agreed consideration. Insert agreed total amount and schedule below.

TERM AND TERMINATION

This Declaration applies to the applicable commercial relationship and shall commence on Start Date: and continue until End Date: unless earlier terminated in accordance with this section.

Either party may terminate for convenience upon notice to the other party given at least Notice Period (days): days prior to the effective termination date.

Buyer may terminate immediately for material breach, including but not limited to Supplier's failure to comply with the mandatory certification items above, subject to any cure period agreed: days.

CONFIDENTIALITY

Each party shall maintain the confidentiality of Confidential Information disclosed by the other party and shall not use such information except as necessary to perform obligations under the scope of work. Confidentiality obligations shall continue for Confidentiality Period (years): years following termination or expiration of this Declaration.

GOVERNING LAW

This Declaration shall be governed by and construed in accordance with the laws of the State of without regard to conflict of law principles. The parties submit to the exclusive jurisdiction of the competent courts located in that state for disputes arising out of this Declaration.

ENTIRE AGREEMENT

This Declaration, together with any applicable purchase orders, statements of work or written agreements expressly incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous understandings, proposals and communications, whether written or oral. Any amendment must be in writing and signed by authorized representatives of both parties.

CERTIFICATION AND ACKNOWLEDGMENT

The undersigned, being duly authorized, certifies under penalty of law that the statements made herein are true, complete and accurate to the best of their knowledge. Supplier agrees to promptly notify Buyer in writing of any material change in the information or representations contained in this Declaration.

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