Waste Management Debris Form

WASTE MANAGEMENT DEBRIS FORM AND SERVICE AGREEMENT

Parties

Generator Name:

Hauler/Provider Name:

WHEREAS

WHEREAS, Generator desires to engage Hauler to collect, transport, and lawfully dispose of non-hazardous debris arising from Generator's project identified below under the terms and conditions set forth in this form; and

WHEREAS, Hauler represents that it is properly licensed, insured, and authorized to perform transportation and disposal services and will exercise industry-standard measures to ensure chain-of-custody, accurate weight reporting, and compliance with applicable waste handling laws; and

WHEREAS, the parties intend this document to serve both as a debris collection ticket and as the controlling commercial agreement governing the scope, payment, documentation, and certifications associated with the debris removal services.

Project Information

Date of First Collection:

Debris Description and Handling

Select applicable debris types (check all that apply):

Construction & Demolition Vegetative/Green Waste Mixed Municipal Debris Recyclable Materials Suspected Contaminated/Other

Quantity, Measurement, and Documentation

Estimated Volume (cubic yards):

Estimated Weight (tons):

Weight Tickets Provided at Disposal: Yes

Disposal & Manifest Information

Facility Manifest Number:

Scope of Work

The following describes the services to be performed by Hauler. Hauler shall furnish labor, equipment, transportation, and disposal as required to remove, transport, and lawfully dispose of the debris described above. Hauler shall comply with all applicable permits, local ordinances, and disposal facility requirements. Hauler shall provide chain-of-custody documentation and weight tickets as required under this agreement.

Payment Terms

Contract Amount (Total): $

Deposit Amount: $

Invoice Frequency:

Late Payment Fee:

Term and Termination

Agreement Start Date:

Estimated Completion / End Date:

Either party may terminate for material breach if such breach is not cured within days after written notice. Immediate termination may occur where illegal or hazardous waste is discovered or where continued performance would violate law or permit conditions.

Confidentiality

Each party shall maintain as confidential all commercially sensitive information, manifests, pricing, and documentation exchanged under this agreement, except where disclosure is required by law, regulatory request, or necessary for prosecution of claims. Confidential information shall not be disclosed to third parties without prior written consent, except to subcontractors or disposal facilities on a need-to-know basis for performance of this agreement, provided such third parties are bound by similar confidentiality obligations.

Compliance, Certification, and Indemnity

Generator certifies that, to its knowledge, the debris described above does not contain regulated hazardous wastes except as specifically disclosed in writing to Hauler. Generator shall identify and segregate any hazardous materials and shall be responsible for all costs, liabilities, and penalties arising from undisclosed hazardous wastes or prohibited wastes. Hauler represents that it will comply with applicable laws, maintain required permits and insurance, and secure proper disposal receipts and weight tickets.

Both parties agree to indemnify and hold harmless the other from claims, costs, damages, and expenses arising from their respective negligence, willful misconduct, or breaches of this agreement, except to the extent caused by the indemnitee's negligence or willful misconduct.

Governing Law; Entire Agreement

This agreement shall be governed by the laws of the state of without regard to its conflicts of law principles. This document, together with any attached manifests, weight tickets, and written amendments signed by both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior oral and written agreements.

Attachments and Additional Records

Attachments included with this form: Weight Tickets Disposal Manifests Permits / Authorization

Signatures and Certifications

By signing below, each signatory certifies under penalty of perjury that they are authorized to bind the party for whom they sign, that the information provided on this form is true and accurate to the best of their knowledge, and that they accept the terms and obligations set forth in this agreement.

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