Surrogate Paperwork Agreement

SURROGATE PAPERWORK AGREEMENT

This Surrogate Paperwork Agreement (the Agreement) is entered into as of Effective Date: by and between Client Name: , Address: , and Surrogate Agent Name: , Address: .

RECITALS (WHEREAS)

WHEREAS, Client retains Surrogate Agent to prepare, complete, file, and otherwise manage specified administrative paperwork, forms, and applications on behalf of Client as further described in this Agreement; and

WHEREAS, Surrogate Agent represents that it has the experience, authority, and ability to perform the Scope of Work set forth below and is authorized by Client to act as agent only to the extent expressly set forth in this Agreement; and

WHEREAS, the parties wish to set forth in writing the terms under which Surrogate Agent will act on Client's behalf with respect to paperwork matters.

SCOPE OF WORK

Surrogate Agent shall perform the tasks described below. Tasks not expressly authorized herein are excluded. Client grants Surrogate Agent the limited authority to sign forms on Client's behalf only where Client has provided explicit written authorization for each such form.

PAYMENT TERMS

Client agrees to compensate Surrogate Agent as follows.

Client shall reimburse Surrogate Agent for reasonable out-of-pocket costs and expenses incurred in performance of the Scope of Work if such costs are pre-approved by Client in writing.

TERM AND TERMINATION

This Agreement commences on Start Date: and continues until End Date: , unless earlier terminated as provided below.

Either party may terminate this Agreement for material breach if the breaching party fails to cure such breach within the notice period specified above. Termination shall not relieve Client of its obligation to pay for services performed and expenses incurred through the effective date of termination.

CONFIDENTIALITY

Surrogate Agent shall treat as confidential all non-public information obtained from Client in connection with the Scope of Work, including personal information and identifying documents. Surrogate Agent shall not use or disclose such information except: (a) as necessary to perform the Scope of Work; (b) with Client's prior written consent; or (c) as required by law, provided Surrogate Agent gives Client prompt notice of any compelled disclosure when permissible.

AUTHORIZATION; ACCESS TO RECORDS

Client authorizes Surrogate Agent to access, obtain, complete, and submit records and forms as necessary to perform the Scope of Work, including but not limited to government forms, medical release forms (if specifically authorized in writing), and benefit applications. Surrogate Agent's authority to sign documents on Client's behalf is limited to documents for which Client has provided specific written authorization in advance.

LIABILITY; INDEMNIFICATION

Surrogate Agent shall perform services with reasonable care and in good faith but shall not be liable for damages arising from delays or errors attributable to Client-supplied information or third-party processing. Client agrees to indemnify and hold Surrogate Agent harmless from claims, liabilities, losses, or expenses arising from Client's misrepresentations or from Client's directions to act in a manner inconsistent with this Agreement.

GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State of , without regard to that State's conflict of laws principles.

ENTIRE AGREEMENT

This Agreement constitutes the entire agreement between the parties regarding the subject matter hereof and supersedes all prior and contemporaneous agreements and understandings, whether oral or written. Any amendment must be in writing and signed by both parties.

REPRESENTATIONS AND CERTIFICATIONS

Each party represents and warrants that it has full authority to enter into this Agreement and that the person signing below is authorized to bind the respective party. Client certifies that the information provided to Surrogate Agent is complete and accurate to the best of Client's knowledge.

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