SUBCONTRACTOR INFORMATION SHEET AND...

SUBCONTRACTOR INFORMATION SHEET AND CHECKLIST Please complete the following information and request documents below for approved sub-contractor status: COMPANY NAME: _____________________________________________________________________

CONTACT NAME: ______________________________________________________________________

ADDRESS:____________________________________________________________________________

CITY: ____________________________________________ STATE: _________ ZIP: ________________

PHONE: ______________________________ FAX: ______________________________________

EMAIL: ______________________________________________________________________________

SERVICES PROVIDED: ___________________________________________________________________

AREAS SERVICED: ______________________________________________________________________

LICENSE#____________ LICENSE TYPE:___________________ EXPIRATION DATE:__________________ DOCUMENT CHECKLIST: ______Subcontract Agreement Signed (mail original) ______ W-9 ______ General Liability Insurance

Minimum $1million/$2million aggregate policy limits.

ServiceMaster Complete Restoration as certificate holder and additional insured ______ Auto Insurance certificate (prefer $1 million policy limit) ______ Workman’s Compensation Insurance

$ 1 million policy limit

or Exemption of Worker’s Compensation Form (request form from us if needed) ______Proof of valid Contractor’s License and bond Please submit all invoices to the mailing address or email address above. If you need to fax send to 760-480-0301 *Please be sure to reference our job number & job site address on all invoice. Any invoices that are incomplete and without this information, will cause a delay in processing. For questions regarding these requirements, please email or call Serena Grantham at [email protected] / 760-480-0208 x1215.

ServiceMaster Complete Restoration 2342 Meyers Ave Escondido, CA 92029-1898 800.376.6678 / 760.480.0208 Fax 760.480.0301

mailto:[email protected]

ServiceMaster: __________ 1 of 14 Subcontractor: ___________

2342 Meyers Ave.

Escondido, CA 92029

Office: 760-480-0208

Fax: 760-480-0301

Contractor’s License # 661120

SUBCONTRACTOR AGREEMENT This Agreement (Subcontract) made as of the _______ day of __________________, 20____

Between, ServiceMaster Complete Restoration (ServiceMaster) with its principal place of business located at 2342 Meyers Ave, Escondido CA 92029, and

Subcontractor: _______________________________________________________________________ With its principal place of business located at: _______________________________________________________________________________________________________

ServiceMaster and Subcontractor may be individually referred to as a “Party” and collectively referred to as the “Parties.”

ServiceMaster has entered into a contract (Subcontract) with Subcontractor: ______________________________________________________________________________________ To perform services of: ______________________________________________________________________________________ ______________________________________________________________________________________ (Brief description of the type of work/service your company provides. Ex. Paint & Drywall, Electrical, Plumbing, etc.) The standards of the industry (hereinafter referred to as the “Subcontract Work”).

TERMS AND CONDITIONS OF AGREEMENT

ServiceMaster and Subcontractor agree as follows:

ARTICLE 1: The Contract Documents The “Contract Documents” include, without limitation: all Project plans/drawings, specifications, addenda, general conditions, special conditions and supplementary conditions, included but not limited to as defined in this Subcontract Agreement (hereinafter referred to as the “Subcontract”) and all documents incorporated into that agreement. Subcontractor’s scope of work may be indicated throughout different parts of the Contract Documents and is also described in a separate addendum to this Subcontract; each Project has a separate addendum. Subcontractor shall perform and complete its entire scope of work no matter where in the Contract Documents that work is described, depicted, or referenced. The Contract Documents are incorporated into this Subcontract by this reference, with the same force and effect as if set forth in full, and Subcontractor and its subcontractors shall be and are bound by any and all of the Contract Documents insofar as they relate in any way, directly or indirectly, to the scope of work set forth in this Subcontract and all addendums to this Subcontract. “Owner” is in reference to the owner or agent of the building the indicated in each addendum to this Subcontract. “Insurance Company” refers to the Owner’s insurance company and all insurance policies in place on the building indicated in each addendums. The Price of the Project is stated in the Project’s Subcontract Addendum. The Price for the Project is based on the itemized scope of work stated in Subcontract Addendum.

ARTICLE 2: Conflicts or Omissions in Subcontract or Contract Documents If Subcontractor believes that there is or may be any conflict between or omission from this Subcontract and the Contract Documents or if Subcontractor has any doubt as to the meaning thereof, Subcontractor shall immediately submit the matter to ServiceMaster for written clarification. Any Subcontract Work performed before receipt of such clarification shall be at Subcontractor’s risk and expense. If any clarification of this Subcontract or other Contract


2342 Meyers Ave.

Escondido, CA 92029

Office: 760-480-0208

Fax: 760-480-0301


Document is needed, ServiceMaster will clarify the same issuing a written order pursuant to Article 8 Changes in the Work. There shall be no increase in the Subcontract Price or extension of the time for completion on account of any mis-description in or omission from this Subcontract or Contract Documents of details of the Subcontract Work which are clearly necessary to carry out the intent of the Contract Documents or which are customarily performed or furnished by contractors performing work similar to the Subcontract Work described in the Subcontract for a complete finished job. Such mis-described or omitted details shall be performed or furnished by Subcontractor at no cost to ServiceMaster as if fully and clearly set forth in the Contract Documents.

ARTICLE 3: Subcontractor Representations Subcontractor represents the following: (a) it is properly licensed to perform this Subcontract; (b) its lower-tier subcontractors, if any, are properly licensed to perform work arising from this Subcontract; (c) it is fully qualified to perform this Subcontract and is experienced in the type of work required by this Subcontract; (d) it has had a sufficient opportunity to review and has carefully examined all of the Contract Documents and the Project site; (e) it has satisfied itself as to the character, quality, and quantity of the Subcontract Work to be performed, the conditions that will be encountered at the Project site or otherwise affect the cost or difficulty of performing the Subcontract Work, the materials and equipment and other items to be furnished, and all other requirements of the Contract Documents and this Subcontract; and (f) it has, by its own independent investigation, ascertained the nature and scope of the Subcontract Work, the conditions involved in performing the Subcontract Work, and the obligations of this Subcontract, and is fully aware of all the obligations, risks, responsibilities, difficulties, and limitations to which the Subcontract Work is subject (g) it is fully capable and experienced in design-build contracting and understands the increased and inherent risks associated therewith. Subcontractor further represents and warrants that it understands and acknowledges that the Contract Documents existing on the date of execution of this Subcontract are not complete; however, Subcontractor is responsible for all work reasonably consistent with the intent of the Contract Documents necessary to produce a complete and fully functional scope of work. Accordingly, any error, ambiguity, inconsistency, or omission in the Contract Documents of which Subcontractor had, or should have had, knowledge of, or work which is consistent with the intent of the Contract Documents to produce a full, complete, and functional scope of work, shall not be a basis for any increase in the amount payable under this Subcontract or time required to perform the Subcontract Work, except to the extent such additional compensation or time extension is actually obtained from ServiceMaster from the Owner pursuant to the procedures in Article 8 on the Changes in the Work.

ARTICLE 4: Subcontractor’s Duties Subcontractor shall furnish and provide all labor, services, materials, installation, cartage, hoisting, supplies, insurance, bonds if required, equipment, scaffolding, tools, and other facilities of every kind and description required for the prompt and efficient performance of its work (unless otherwise specified in Subcontract Addendum). Subcontractor’s scope of work is described in a Subcontract Addendum issued for each project. The Subcontract Work is not limited by any titles on the drawings or headings in the specifications, it being the intention of the Parties that all work customarily performed with the Subcontractor Work shall be performed by Subcontractor, including any and all items and services consistent with, contemplated by, and reasonable inferable from, the Contract Documents and reasonably necessary to provide a complete and fully functioning scope of work, whether or not such items and services are specifically mentioned therein, unless specifically excluded by Subcontractor in the Subcontract. Subcontractor shall abide by that determination and shall perform the disputed item(s) of work. Subcontractor’s sole remedy shall be to pursue a claim for such work pursuant to the “Resolution of Disputes” section of the Subcontract. Subcontractor shall, prior to submission of his first requisition for payment, supply to ServiceMaster the name, address and telephone number of every supplier or Subcontractor furnishing materials and/or labor to Subcontractor for the Work covered herein and a cost breakdown of this Subcontract.

ARTICLE 5: The Time of Commencement and Completion of the Subcontract Work Subcontractor shall be notified when the Project commences and shall be given by ServiceMaster at that time an estimated date for the commencement and completion of the Subcontract Work. ServiceMaster shall thereafter give Subcontractor notice of the actual scheduled commencement and completion of the Subcontract Work. Subcontractor agrees to use its best efforts to meet all schedules thereby established and understands and


2342 Meyers Ave.

Escondido, CA 92029

Office: 760-480-0208

Fax: 760-480-0301


acknowledges that ServiceMaster and other subcontractors will rely on Subcontractor’s timely performance of the Subcontract Work.

ARTICLE 6: Payments 1) Applications for Payment/Invoice: Subcontractor shall submit to ServiceMaster applications for payment or

invoice in a form acceptable to ServiceMaster and for a time period as directed by ServiceMaster not later than the date prescribed by ServiceMaster. Applications shall be for payment for materials incorporated in the work and work performed in place during the time period since Subcontractor commenced its work or since its last application for payment/invoice, whichever is later. Subcontractor agrees to furnish, as and when required by ServiceMaster, affidavits, receipts, vouchers, lien waivers, releases of claims for labor, material and subcontractors performing work or furnishing materials under this agreement, and any other documents reasonably requested by ServiceMaster, all in form satisfactory to ServiceMaster, and it is agreed that no payment hereunder shall be made, except at ServiceMaster’s option until and unless such documents have been furnished. In addition to the foregoing, prior to receiving any payment, Subcontractor must furnish ServiceMaster with a valid certificate of insurance that meets the requirements in Article 9 and maintain a valid contractor’s license that meets the requirements in Article 10.

2) Timing of Payments: ServiceMaster shall make progress payments to Subcontractor upon receipt and

approval by the Project Manager of an acceptable application of payment/invoice. Subcontractor and will be paid within 45 days from receipt of the approved progress payment only if the project is satisfactory and meets all requirements stated in this Subcontract Agreement.

3) Stored Materials: If payment is requested on account of materials or equipment not incorporated in the work but delivered and suitably stored on site or off site at some other location agreed upon in writing, payment for such materials or equipment shall be made in accordance with the terms and conditions as allowed by the Contract Documents. In such cases: (1) insurance shall be provided with ServiceMaster and Owner’s names on the policy, and Subcontractor shall furnish detailed inventory, including invoices, for all such stored materials, and (2) Subcontractor shall comply with such other procedures satisfactory to the Owner and ServiceMaster to establish the Owner’s title to such materials and equipment, or otherwise to protect the Owner’s and Contractor’s interest including transportation to the site. If the Contract Documents do not permit payment for stored materials, then no such payment will be made. Subcontractor shall, prior to submission of his first requisition for payment, supply to ServiceMaster the name, address and telephone number of every supplier or Subcontractor furnishing materials and/or labor to Subcontractor for the work covered herein and a cost breakdown of this Subcontract Agreement.

4) Final Payment - Retention: Subject to the terms of this Subcontract Agreement final payment shall be due in

45 days from receipt and approval of final progress payment/invoice when the Subcontract Work is fully completed and performed in accordance with the Contract Documents, a Statement of Satisfaction form is completed all unconditional final releases have been submitted by Subcontractor and all suppliers, vendors and mechanics liens, Notice of Completion is signed by Owner and approved by homeowner and Project Manager. Such completion and performance is satisfactory to ServiceMaster. Before ServiceMaster will issue the final payment to the Subcontractor, the Subcontractor, if requested by ServiceMaster, shall submit evidence satisfactory to ServiceMaster that all payrolls, bills for materials and equipment, and known indebtedness connected with the Subcontractor’s performance of the Subcontract Work have been satisfied.

ARTICLE 7: Acceptance 1) Acceptance. It is understood and agreed that no payment to Subcontractor shall constitute an acceptance or

approval of any labor or material performed or furnished by Subcontractor, nor shall any filing of notice of completion or occupancy of the Project, in whole or in part, constitute an acceptance or approval by ServiceMaster, in whole or in part, of the work or a waiver of any claims or back-charges by ServiceMaster against Subcontractor.

2) Disputes. In the event of a good faith dispute arising from Subcontractor’s performance, including, but not limited to, deficient materials and/or workmanship, ServiceMaster may withhold up to 150% of the disputed amount.


2342 Meyers Ave.

Escondido, CA 92029

Office: 760-480-0208

Fax: 760-480-0301


3) Reductions from Payment. ServiceMaster may withhold or nullify, in whole or in part, any payment to

Subcontractor to such extent as may be necessary to protect ServiceMaster from loss, including costs and attorney’s fees, on account of any one of the following: (1) defective work not remedied; (2) claims filed or reasonable evidence indicating the probably filing of a claim against Subcontractor, or against ServiceMaster, Insurance Company, Owner, or the Project as a result of any action or inaction by Subcontractor; (3) failure of Subcontractor to make proper payments to its subcontractors or suppliers, or for any material, labor, equipment of fringe benefits; (4) a reasonable doubt that this Subcontract can be completed for the balance then unpaid; (5) damage to another subcontractor; or (6) Subcontractor’s failure to strictly adhere to every term and condition of this Subcontract. If required by ServiceMaster and before payment to Subcontractor, Subcontractor shall provide lien or claim waivers for any subcontractors, material men, and suppliers used to complete the Subcontract Work.

ARTICLE 8: Changes in the Work 1) ServiceMaster may authorize changes to or deductions from the Subcontract Work, said authorization to be

effective and binding only when written (hereinafter referred to as "extra work"). 2) Whenever extra work is requested by ServiceMaster and the scope and nature of same is reasonably

susceptible to lump sum quotation, Subcontractor shall provide such quotation within five (5) days of a request for same.

3) Any claim for compensation for extra work, whether lump sum or otherwise, must be presented to ServiceMaster within five (5) days of authorization of the extra work. Claims for extra work received thereafter will not be considered. Proper claims for extra work shall be paid in accordance with this Subcontract Agreement.

4) Duly authorized extra work is hereinafter deemed included in the "Subcontract Work". No dispute as to adjustments in the Contract Amount for extra work shall excuse Subcontractor from proceeding with the Subcontract Work.

5) ServiceMaster, without nullifying the Subcontract, may direct Subcontractor to make changes to Subcontractor's Work. Adjustment, if any, in the contract price or contract time resulting from such changes shall be set forth in a Subcontractor's Change Order pursuant to the Contract Documents.

ARTICLE 9: Insurance Subcontractor is required to provide a Certificate of Insurance prior to starting work. ServiceMaster shall be added as an Additional Insured on each subcontractor General Liability policy, verified by a Certificate of Insurance and receipt of the Additional Insured form. Limits on the Subcontractor’s General Liability for Premises/Operations and Products/Completed Operations shall be equal to or greater than $1,000,000.00 per claim $2,000,000.00 General Aggregate Liability with independent contractors, products completed operations hazard with contractual coverage. Workers' Compensation Insurance (Statutory Maximum at Job Site location) and Employees Liability Insurance and Comprehensive Automobile Liability Insurance ($1,000,000.00 combined single limit) shall be furnished to ServiceMaster in duplicate of original copies of insurance certificates evidencing compliance with the foregoing insurance requirements, naming SBRM, Inc. dba ServiceMaster Complete Restoration as additional insured. All policies shall provide a ten (10) day cancellation or change notice to ServiceMaster in the event of any change in or cancellation of said policies. The indemnification obligations under Section 21 shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for Subcontractor under Workers' Compensation Acts, Disability Benefit Acts or Other Employee Benefits Acts. (These limits are subject to change.) 1) ServiceMaster and Subcontractor waive all rights against each other for damages by fire or other perils

covered by property insurance set forth in the General Contract except for proceeds of insurance held by Owner as trustee. ServiceMaster shall be named additional insured on the certificate of insurance.

ARTICLE 10: Contractor’s License Subcontractor is required by law to be licensed and regulated by the Contractors State License Board. Subcontractor now possesses and shall at all times possess for the entire life of this Agreement all licenses Required to lawfully perform the Subcontract Work. Any questions concerning a contractor may be Referred to the Registrar, Contractors State License Board, 9821 Business Park Drive, Sacramento, California 95827. Mailing Address: P.O. Box 26000, Sacramento, California 95826.


2342 Meyers Ave.

Escondido, CA 92029

Office: 760-480-0208

Fax: 760-480-0301


ARTICLE 11: Time/Scheduling Time is of the essence of this Subcontract. Subcontractor shall conform to ServiceMaster’s progress schedules, subject to ServiceMaster’s modification. Subcontractor shall begin work as soon as instructed by ServiceMaster. Prior to commencement of the Subcontract Work, Subcontractor shall meet with ServiceMaster to review Project schedules, payment procedures, and the Subcontract Work. Subcontractor shall perform the Subcontract work promptly, efficiently, and at a speed that will not cause delay in the progress of ServiceMaster’s work or the work of others. Subcontractor shall prepare and obtain approval as required by the Contract Documents for all shop drawings, details, samples, and do all other things necessary and incidental to the prosecution of its work in conformance with the progress schedules or, if not specified in the progress schedules, then within the time required by ServiceMaster. Subcontractor shall coordinate its work with that of all others in a manner that will facilitate the efficient completion of the entire work. If, in the opinion of ServiceMaster, Subcontractor falls behind in the progress of the work, ServiceMaster may direct Subcontractor to take such steps as ServiceMaster deems necessary to improve the rate of progress, including, without limitation, requiring Subcontractor to increase the number of shifts, personnel, overtime operations, days of work, equipment, or other remedies without additional cost to ServiceMaster. ServiceMaster may require Subcontractor to prosecute, in preference to other parts of work, such part or parts of the work as ServiceMaster may specify. No claims for additional compensation or damages for delays, disruption, compression, acceleration, labor inefficiencies, suspensions of work, material cost escalation, extended overhead, schedule impacts, or any other delay damages (Schedule Claims), whether caused in whole or in part by the negligence, breach of contract, or other act of ServiceMaster, shall be recoverable from ServiceMaster or ServiceMaster’s surety. However, in the event, and in such event only, that ServiceMaster obtains additional compensation from owner on account of any such Schedule Claims, Subcontractor shall be entitled to such portion of the additional compensation so received by ServiceMaster as is equitable under all of the circumstances. Nothing herein contained shall require ServiceMaster to make any claim against owner for such Schedule Claims, and it is specifically agreed that the failure of ServiceMaster to prosecute any such Schedule Claims shall not entitle Subcontractor to any claim for damages against ServiceMaster.

ARTICLE 12: Supervision/Omissions Subcontractor shall provide efficient and knowledgeable supervision of its work, using its best skill and attention. Subcontractor shall carefully study and compare all drawings, specifications, and other instructions concerning the work, and shall at once report to ServiceMaster, in writing, any error, inconsistency, or omission which it discovers. Should Subcontractor fail to perform its duties under this paragraph, or perform them negligently, Subcontractor shall be liable to ServiceMaster for any resulting damages to ServiceMaster.

ARTICLE 13: Workmanship Every part of Subcontractor’s work shall be executed in strict accordance with the Contract Documents in the most sound, workmanlike, and substantial manner. All workmanship shall be of a superior quality, and all materials used by Subcontractor shall be furnished in ample quantities to facilitate the proper and expeditious execution of the work and shall be new, except such materials as may be expressly provided in the Contract Documents to be otherwise.

ARTICLE 14: Safety and Accident Prevention In performing this Subcontract, Subcontractor shall protect the lives and health of employees and other person’s, prevent damage to property, materials, supplies, and equipment, and avoid work interruptions. For these purposes, Subcontractor shall, for its scope of work: 1) Require that hardhats, safety glasses and PPE’s are worn at all times during working hours at the job site.

Workers should not be on site without a hardhat of their own. ServiceMaster may assess fees per occurrence for non-compliance. Additional fines may be assessed for non-compliance within OSHA guidelines.


2342 Meyers Ave.

Escondido, CA 92029

Office: 760-480-0208

Fax: 760-480-0301


2) Provide appropriate safety equipment and signal lights. Subcontractor will closely coordinate its activities with

other on-site contractors in order to prevent an unsafe working environment. If safety devices are erected or installed by others (such as a lifeline) and used by Subcontractor’s employees, it is Subcontractor’s responsibility to inspect such devices and, as between ServiceMaster and Subcontractor, Subcontractor accepts sole responsibility for use of such safety devices in accordance with local, state, and federal safety and health laws, orders, or regulations. If equipment or materials are provided by or available from others on site (such as ladders, scaffolding, and forklifts), prior to their use by Subcontractor, Subcontractor shall obtain the written consent of the provider, and it is Subcontractor’s responsibility to inspect such equipment and materials and, as between ServiceMaster and Subcontractor, Subcontractor accepts sole responsibility for use of such equipment and/or materials in accordance with all local, state, and federal safety and health laws, orders, or regulations.

3) Provide all certifications/training for the operation of all equipment used to perform Subcontractor’s work, i.e., Scaffold training, Scissor Lift, etc. In addition, Subcontractor shall provide training certifications for CPR, First Aid, Competent Person and any other applicable safety documentation.

4) Comply with all local, municipal, state, and federal safety and health laws, orders, and regulations applicable to Subcontractor’s operations. Any conflicts between such laws, orders, or regulations will be resolved in favor of the stricter safety requirement. While on the Project site, Subcontractor and its employees shall comply with the requirements of the Occupational Safety and Health Act of 1970 (84 U.S. Stat. 1590), as amended, and any State plan similar to such Act, and the regulations thereunder, to the extent applicable.

5) Comply with the safety, health, and the site regulations and plans of ServiceMaster, Insurance Company and Owner, and shall ensure that all of Subcontractor’s employees, contractors, and agents have a safe place to work at all times.

6) Establish a safety program, regardless of whether ServiceMaster establishes a safety program for the entire Project, implementing safety measures, policies and standards conforming to those required or recommended by governmental and quasi-governmental authorities having jurisdiction, and by ServiceMaster, Insurance Company and Owner, including, but not limited to, requirements imposed by the Contract Documents. Subcontractor shall comply with the recommendations of ServiceMaster’s and/or Owner’s insurance companies and/or Owner having an interest in the Project, and shall suspend any part of the work which ServiceMaster deems unsafe until corrective measures satisfactory to ServiceMaster are taken. ServiceMaster’s failure to suspend Subcontractor’s unsafe practices shall not relieve Subcontractor of the responsibility for the unsafe practices. Subcontractor shall notify ServiceMaster immediately following any accident and promptly confirm the notice in writing.

7) Maintain an accurate record of all accidents which occur that are in any way related or incidental to its work which result in death, injury, occupational disease, or damage to property, materials, supplies or equipment. Subcontractor shall provide ServiceMaster copies of all accident reports filed with federal, state, and local government agencies and such additional data as may be requested by ServiceMaster.

8) Require that all of its on-site employees, as well as its subcontractor’s or consultants’ on-site employees, attend all safety meetings required by Owner or ServiceMaster related to the project.

9) Be responsible for securing equipment left on-site after working hours to prevent unauthorized operation or access.

10) While it is Subcontractor’s sole responsibility and obligation to furnish a safe place to work for its employees, ServiceMaster may notify Subcontractor of any noncompliance with these requirements and of the corrective action required. This notice, when delivered to Subcontractor or Subcontractor’s representative at the site of work, shall be deemed sufficient notice of the noncompliance. After receiving the notice, Subcontractor shall immediately take corrective action. If Subcontractor fails or refuses to take corrective action promptly, ServiceMaster may issue an order suspending all or part of the work until satisfactory corrective action has been taken. Subcontractor shall not base any claim or request for equitable adjustment for additional time or money on any suspension issued under these circumstances.

ARTICLE 15: Governmental Requirements, Regulations, Acts, and Statutes Subcontractor is an independent contractor and shall, at its sole cost and expense, and without increase in the Subcontract Price, comply with all laws, rules, ordinances, and regulations of all governing bodies or quasi-government entity having jurisdiction over the Project, the Project Site, the practices involved in the Project, or any Subcontract Work. Subcontractor must obtain all necessary permits and licenses therefore, and pay all manufacturer’s taxes, sales taxes, use taxes, processing taxes and all salaries, or other remunerations paid to Subcontractor’s employees, whether levied under existing or subsequently enacted laws, rules, or regulations. Subcontractor, upon request, shall furnish evidence satisfactory to ServiceMaster that any or all of the foregoing obligations have been fulfilled.


2342 Meyers Ave.

Escondido, CA 92029

Office: 760-480-0208

Fax: 760-480-0301


Particular attention is called, but not limited, to those requirements, regulations, statutes and acts related to safety, equal employment opportunity, wage and hours, and environmental and hazardous/toxic material. Subcontractor also agrees to specifically take note and comply with the following. 1) NOTICE OF RIGHTS TO EMPLOYEES UNDER THE NLRA. During the term of this Subcontract,

Subcontractor agrees to post a notice, of such size and in such form, and containing such content as the Secretary of Labor shall prescribe, in conspicuous places in an about its plants and offices where employees covered by the National Labor Relations Act engage in activities relating to the performance of the Subcontract, including all places where notices to employees are customarily posted both physically and electronically. The Notice shall include the information set forth in 29 C.F.R. Part 471, Appendix A.

2) AIR POLLUTION CONTROL. Subcontractor agrees to comply with all federal, state and local air pollution control rules, regulations, ordinances, and statutes which apply to the Subcontract Work. Subcontractor is responsible for compliance with all California Air Resources Board (CARB) regulations and reporting duties, and shall keep apprised of the various rules, regulations, and ordinances of California’s 35 local air districts. If Owner is a state agency, Subcontractor shall specifically comply with the requirements of Public Contract Code section 10231.

Subcontractor, as part of its compliance, shall become aware of, and readily comply with, any notification and/or reporting requirements of these regulations, statutes, acts, and the associated penalties and deductions for any failure to comply. Subcontractor shall ensure and be responsible for similar compliance by all those working under Subcontractor in performance of its work. Subcontractor agrees it shall not publicly release information, photographs or other documents concerning any aspects of the materials or services relating to this bid, Subcontract or purchase order without prior written approval of ServiceMaster, Insurance Company and Owner. FAILURE TO COMPLY. Failure of Subcontractor, or anyone working under it, to comply with the requirements, regulations, statutes or acts, as described in subparagraph , above, shall constitute a material breach of this Subcontract by Subcontractor, and ServiceMaster may in its discretion exercise all of the rights and remedies provided by law or under the terms of this Subcontract, including, but not limited to, withholding of a sum equal to 150% of the amount ServiceMaster reasonably believes it may be damaged by reason of such breach.

ARTICLE 16: Provision for Inspection Subcontractor shall furnish to ServiceMaster, Insurance Company and Owner and their representatives ample facilities at all times for inspecting materials at the site of construction, at the shops, or any place where materials under the Subcontract may be in the course of preparation, process, manufacture or treatment. Subcontractor

shall furnish to ServiceMaster, as often as required by ServiceMaster, full reports of the progress of the work at any place where materials under the Subcontract may be in the course of preparation or manufacture, said reports to show the progress of such preparation and manufacture in such details as may be required by ServiceMaster, including any plans, drawings, or diagrams in the course of preparation. ServiceMaster, Insurance Company and/or Owner may have a full or part time quality control individual or inspector on the site or may conduct inspections of all or any part of the work at various times. Any such person or inspection shall not relieve or diminish in any way Subcontractor’s responsibility for ensuring that its subcontract work is in full and complete compliance with the Contract Documents and approved by ServiceMaster, Insurance Company and Owner. Subcontractor cannot defend against poor, improper, substandard, incorrect, or non-complying work or materials by arguing that said work or materials were inspected and/or approved by Owner, Insurance Company, or ServiceMaster.

ARTICLE 17: Materials Furnished by Others In the event Subcontractor’s scope of work includes installation of materials or equipment furnished by others, it is Subcontractor’s responsibility to examine the items so provided and to handle, store and install the items with such skill and care as to ensure a satisfactory installation. Loss or damage due to actions or inactions of Subcontractor shall be charged to the account of Subcontractor and deducted from monies due under the Subcontract.


2342 Meyers Ave.

Escondido, CA 92029

Office: 760-480-0208

Fax: 760-480-0301


ARTICLE 18: Protection of Work All work covered by this Subcontract, done at any site of construction, or in preparing or delivering materials or equipment, or any or all of them, to a site, shall be at the risk of Subcontractor exclusively. Insurance Company, Owner and ServiceMaster are not providing course of construction insurance. Subcontractor shall obtain and pay for such insurance to protect against risk of loss to Subcontractor’s material, whether in transit, stored or installed. Subcontractor shall effectively secure and protect the work done under the Subcontract, and assume full responsibility for its condition until final acceptance by Insurance Company, Owner and ServiceMaster. Subcontractor shall agree to provide such protection as is necessary to protect the work and the workmen of ServiceMaster and other subcontractors from Subcontractor’s operations. Subcontractor shall be liable for any loss or damage to any work in place or to any equipment and materials on the job site caused by any action or inaction of Subcontractor or its agents, employees, or guests.

ARTICLE 19: Clean-Up During the course of construction, Subcontractor shall remove waste materials from the site recurrently as is necessary to maintain the premises in a clean and orderly condition. Upon completion of its work, Subcontractor shall remove from the site all temporary structures, debris and waste incident to its operations and clean all surfaces, fixtures, equipment, etc., relative to the performance of the Subcontract. If Subcontractor fails to perform a clean-up function on a daily basis, ServiceMaster may proceed with that function as it judges necessary, without additional notification, and in the manner ServiceMaster deems expedient, and the resulting costs shall be charged to Subcontractor and deducted from monies due under the Subcontract. Should it be impossible for Subcontractor to leave the premises in a clean, broom swept condition because of the continuing work of other subcontractors, Subcontractor agrees to share on a prorated basis with the other subcontractors the cost of clean-up, the proration of such costs to be made by ServiceMaster.

ARTICLE 20: Recourse In the event that Subcontractor at any time refuses or neglects to supply a sufficient number of properly skilled workmen or a sufficient quantity of materials of proper quality, or be adjudicated as bankrupt, or files an arrangement proceeding, or commits any act of insolvency, or makes an assignment for benefit of creditors without ServiceMaster’s consent, or fails to make prompt payment to his material men and laborers, or fails in any respect to properly and diligently prosecute the work covered by the Subcontract, or becomes delinquent with respect to contributions or payments required to be made to any Health and Welfare, Pension, Vacation, Apprenticeship, or other employee benefit program or trust, or fails to fulfill any of the provisions of the Subcontract, ServiceMaster may, at its option, after giving forty-eight (48) hours written notice to Subcontractor, cure any such failure and deduct the resulting cost including a markup of 10% General Overhead and 10% profit, from any money then due or at any time later due to Subcontractor under the Subcontract, or ServiceMaster may, at its option, terminate Subcontractor’s right to proceed with the work, and, in that event, ServiceMaster shall have the right to enter upon the premises of the Project and take possession for the purpose of completing the work included under the Subcontract of all materials, tools, and appliances of Subcontractor, and may employ any other person or persons to finish the work and provide any needed materials. In case of such termination of Subcontractor’s right to proceed with the work, Subcontractor shall not be entitled to receive any further payment under the Subcontract until the work undertaken by ServiceMaster in the Contract Documents is completely finished. At that time, if the unpaid balance of the amount to be paid under the Subcontract exceeds the expenses incurred by ServiceMaster in finishing Subcontractor’s work, such excess shall be paid by ServiceMaster to Subcontractor, but if the expenses incurred by ServiceMaster in finishing Subcontractor’s work exceed the unpaid balance, then Subcontractor shall promptly pay to ServiceMaster the amount by which such expenses exceed the unpaid balance. The expenses referred to in the last sentence shall include expenses incurred by ServiceMaster for furnishing materials, labor and/or equipment for finishing the work, and any damages sustained by ServiceMaster by reason of Subcontractor’s default, plus a markup of 10% General Overhead and 10% profit on any and all of such expenses, and ServiceMaster shall have a lien upon all materials, tools, and appliances taken possession of to secure payment by Subcontractor. The notice referred to in this paragraph will be sufficient and complete when faxed or mailed to Subcontractor at its address as shown in the Subcontract. If Subcontractor is terminated under this Section and it is later determined in a court or arbitration proceeding that such termination was without cause, Subcontractor’s damages shall not exceed the amount available to it for termination under this Agreement.


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ARTICLE 21: Indemnities To the fullest extent permitted by law, Subcontractor shall, with respect to all work which is covered by or incidental to the Subcontract, indemnify, defend and hold ServiceMaster, and its agents, employees, officers, directors, shareholders, representatives, and independent contractors (Indemnified Parties), harmless from and against the following: 1) General

a. Subcontractor agrees to indemnify and save ServiceMaster, Insurance Company and Owner harmless against

and from any and all claims arising from the conduct, management or performance of the Subcontract Work, including without limitation, any and all claims arising from any condition or the Subcontract Work arising from any breach or default of the part of Subcontractor in the performance of any covenant or agreement on his part to be performed, pursuant to the terms of this Subcontract or arising from any act or negligence of Subcontractor or any of his agents, Subcontractors, employees or licensees and in case any action or proceeding is brought against ServiceMaster, shall defend against such action or proceeding using counsel satisfactory to ServiceMaster, unless such action or proceeding is defended against by counsel for any carrier of public liability or other insurance referred to herein.

b. Any claim, liability, loss, damage, cost, expense, including reasonable attorneys’ fees, awards, fines or judgments arising by reason of the death or bodily injury to persons, injury to property, design defects (if design originated by Subcontractor), or other loss, damage or expense; due to any act or omission of Subcontractor and

c. Any and all claims, liability, loss, damage, costs, including reasonable attorneys’ fees, awards, fines or judgments arising by reason of any obligation to indemnify which ServiceMaster has to Owner. Insurance Company, or their agents, employees, officers, directors, shareholders, representatives, independent contractors, designers, consultants, engineers, suppliers or subcontractors.

2) Substitutions

All liabilities of any nature whatsoever, including but not limited to, extra costs, delays, damages asserted by Insurance Company Owner., other contractors, subcontractors, or any third party, as a result of substitutions of specified materials or products, whether or not Subcontractor has obtained approval for the submission.

3) Patent Rights

Any and all claims, liability, loss, damage, costs, including reasonable attorneys’ fees, awards, fines or judgments arising from or relating to any suit or action, or any alleged violation or infringement of patent rights which may be made against ServiceMaster by reason of the use in connection with or as a part of the performance of Subcontractor’s work, including the furnishing of the materials, of anything which is now or may later be covered by patent, copyright or trademark, and also against all expenses, including attorneys’ fees, which ServiceMaster may incur in defending or adjusting any such claim, suit or action.

4) Use of ServiceMaster’s Equipment

Any and all claims, liability, loss, damage, costs, including reasonable attorneys’ fees, awards, fines, or judgments arising from or relating to Subcontractor’s or any of its agents’, employees’, or representatives’, use of ServiceMaster’s equipment or facilities.

5) Government Requirements, Regulations, Acts, and Statutes

Any and all claims, liability, loss, damage, costs, including reasonable attorneys’ fees, awards, fines or judgments arising from or relating to Subcontractor’s or any of its agents’, employees’, or representatives’, use of ServiceMaster’s equipment or facilities.

6) Safety and Accident Prevention

Any and all claims, liability, loss, damage, costs, including reasonable attorneys’ fees, awards, fines, or judgments arising from or relating to any claim brought against Owner, Insurance Company, or ServiceMaster by employees of Subcontractor or its subcontractors alleging that Owner, Insurance Company, or ServiceMaster negligently failed to furnish a safe work place, and any fines, damages or expenses incurred by ServiceMaster because of Subcontractor’s failure to comply with safety requirements.

7) Each of the foregoing indemnities and duties to defend are independent, and all shall be given effect.

Subcontractor’s obligation to defend and indemnify Indemnified Parties under and indemnity set forth above


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shall include the obligation to defend and indemnify Indemnified Parties regardless of whether any claim, liability, loss, damage, cost, or expense is alleged to have resulted from Indemnified Parties’ alleged or actual passive negligence. However, Subcontractor shall not be obligated under the Subcontract to indemnify or defend an Indemnified Party with respect to the sole or active negligence, or willful misconduct, of the Indemnified Parties, or for defects in design furnished by the Indemnified Parties. Subcontractor’s obligation to defend an Indemnified Party shall arise immediately upon a written tender of claims by ServiceMaster to Subcontractor. Upon tender by ServiceMaster, Subcontractor shall timely elect to defend or pay for ServiceMaster’s defense in violation of California law; the Parties agree that Subcontractor shall be liable to ServiceMaster for all resulting compensatory and consequential damages, including attorneys’ fees. Subcontractor’s duty to defend applies even if such claims or suits are groundless, false, or without merit. ServiceMaster’s tender of defense to Subcontractor shall not waive, alter, or modify, or be used to limit, ServiceMaster’s right to insurance coverage provided by Subcontractor under the provisions of this Subcontract. To the fullest extent permitted by law, Subcontractor also agrees to indemnify Owner and Owner’s agents and independent contractors to the same extent and in the same manner in which ServiceMaster must indemnify Owner and Insurance Company. This indemnification shall extend to claims occurring after this Subcontract is terminated as well as while it is being performed.

ARTICLE 22: Sub-Tier Claims Subcontractor shall at all times indemnify, defend, and save ServiceMaster, Insurance Company and Owner harmless from and against all liability for claims for labor performed or materials or equipment used or furnished to be used on the Project related to or arising out of the Subcontract Work, including any costs and expenses for attorney’s fees and all incidental or consequential damages resulting to ServiceMaster, Insurance Company or Owner from such claims. Further, in case suit on such claims is brought, Subcontractor shall defend said suit at its own cost and expense, and will pay and satisfy and such claim or judgment as may be established. Subcontractor agrees within ten (10) days after written demand to cause the effect of any claim or suit to be removed, and in the event Subcontractor shall fail to do so, ServiceMaster is authorized to use whatever means in its discretion it may deem appropriate to cause said claim or suit to be removed or dismissed and the resulting cost, together with reasonable attorneys’ fees, shall be immediately due and payable to ServiceMaster by Subcontractor. Subcontractor may litigate any such claim or suit provided it does such things as may be necessary to prevent Insurance Company and Owner from withholding any monies due to ServiceMaster by reason of such claim or suits.

ARTICLE 23: Termination In the event the Subcontract is terminated prior to its completion, Subcontractor shall be entitled only to payment for the work actually completed by it at the pro rata price set forth in the Subcontract unless ServiceMaster itself receives additional compensation for damages on account of such termination, in which event Subcontractor shall be entitled to such proportion of the additional compensation for damages actually received as is equitable under all of the circumstances. Nothing in the Subcontract shall require ServiceMaster to make any claim against Insurance Company or Owner for such additional compensation or damages in the event of termination before completion and the failure of ServiceMaster to prosecute any such claim against Insurance Company or Owner shall not entitle Subcontractor to any claim for additional compensation or damages against ServiceMaster. Notwithstanding the preceding paragraph, ServiceMaster reserves the absolute right to terminate the Subcontract. In the event of termination without cause, Subcontractor shall be entitled to payment only as follows: 1) Reasonable value of the Subcontract Work completed in conformity with the Subcontract; plus 2) Other costs actually incurred by Subcontractor for performance of the Subcontract for performance of the

Subcontract; plus 3) Five percent of costs referred to in Paragraph 1 above, for overhead and profit. There shall be deducted from

such sums as provided in this Section the amount of any payments made to Subcontractor prior to the date of termination of the Subcontract. Subcontractor shall not be entitled to any claim against ServiceMaster, Insurance Company, or their sureties, or against Owner for any additional compensation or damages in the event of such termination and payment, including any claim for lost profits, overhead costs, and/or consequential damages.

ARTICLE 24: Warranty


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Subcontractor agrees to provide a minimum one year warranty, or such longer period as required by the Contract Documents. The terms of the warranty shall be as provided below, or by the Contract Documents. ServiceMaster will endeavor to notify Subcontractor of the length of warranty period on the Subcontract Addendum, and terms of the warranty if different than that provided below, but in the event of an inconsistency between the Subcontract Addendum and Contract Documents respecting the length or terms of the warranty, the Contract Documents will control. Subcontractor agrees to contact Contractor or Owner within 48 hours after receiving a request for warranty work. Warranty work will need to be performed and will promptly correct the problem within five (5) working days at Subcontractor’s expense other than in emergency situations. Subcontractor warrants to Owner, Insurance company and ServiceMaster or that all materials and equipment furnished shall be new, unless otherwise specified, and that all Subcontract Work shall be free from faults and defects and in conformance with the Subcontract Documents. All work not conforming to these requirements, including substitutions not properly approved and authorized in writing, shall be considered defective.

ARTICLE 25: Resolution of Disputes 1) Claims Involving Insurance Company Or Owner And Pass-Through Claims – In the event Subcontractor

desires to assert a claim against or seek other relief from the Insurance Company or Owner, with the assistance of ServiceMaster, or against ServiceMaster where ServiceMaster may be entitled to similar relief from Insurance Company or Owner, then Subcontractor shall comply with and provide to ServiceMaster such notices, claims, certifications and other administrative requirements of the Contract Documents, and any applicable insurance policies, in such manner and at times sufficient to permit ServiceMaster to promptly and thoroughly give notices, present and document claims, or other requests for relief, to the Owner and/or Insurance Company.

a) To the extent ServiceMaster determines Subcontractor’s claim is one for which Insurance Company

and/or Owner may be liable, the following procedure shall apply:

i) ServiceMaster will present Subcontractor’s claim to Owner and/or Insurance Company’s first level designated representative. The decision of such representative will be conveyed in writing to Subcontractor and such decision shall be final unless Subcontractor notifies ServiceMaster in writing of its desire to proceed further in sufficient time for ServiceMaster to comply with any notification or submission requirements by Owner and/or Insurance Company.

ii) Upon receipt of Subcontractor’s notice to proceed further, at ServiceMaster’s option, Subcontractor’s claim may be further pursued with Owner and/or Insurance Company. In such event, ServiceMaster may allow Subcontractor to act in its own behalf and with its own consultants/attorneys at Subcontractor’s cost to continue the required process and any subsequent administrative proceeding or litigation. If ServiceMaster does not allow Subcontractor to proceed in its own behalf or it is procedurally impermissible for Subcontractor to proceed in its own behalf, and ServiceMaster elects to allow the continued pursuit of Subcontractor’s claim, then at the written request of Subcontractor, ServiceMaster will proceed with the dispute on condition that Subcontractor pay to ServiceMaster all of its actual costs arising out of such process, including, but not limited to, attorneys’ fees, court costs and the costs of ServiceMaster’s personnel employed in pursuing the case.

(1) If ServiceMaster elects to not allow further pursuit of Subcontractor’s claim, and Subcontractor

disputes such decision, Subcontractor may pursue its claim pursuant to the procedures set forth below for “Claims Not Involving Owner and/or Insurance Company.”

(2) Nothing shall prevent ServiceMaster from accepting a contract modification from Owner and/or

Insurance Company which preserves the rights of Subcontractor.

(3) If because of Subcontractor’s claim, Owner and/or Insurance Company withholds any sums due ServiceMaster, then Subcontractor shall pay to ServiceMaster interest on the amounts so withheld at the maximum rate allowed by law.

2) Claims Not Involving Owner and/or Insurance Company – To initiate the dispute resolution process, the complaining Party shall write a description of the alleged breach of contract and send it to the other Party by certified or registered mail. This letter shall explain the nature of the complaint and refer to the relevant Section of the Subcontract upon which the complaint is based. The complaining Party shall also set forth its


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claim amount and how it was calculated and/or a proposed solution to the problem. Unless ServiceMaster and Subcontractor agree in writing upon an alternative dispute resolution method for any non-Insurance Company, non-Owner or pass-through dispute arising out of or relating to the Subcontract, the following provisions shall apply:

a) Venue – The Subcontract was entered into in the Escondido, San Diego County, California. Venue for all

controversies or claims arising from or relating to the Subcontract shall be Escondido, San Diego County, California.

b) Choice of Law – In any litigation or arbitration solely between ServiceMaster and/or its surety, and Subcontractor and/or its surety, the Subcontract shall be governed by the laws of the State of California.

c) Mediation/Arbitration – Any controversy or claim between ServiceMaster (and/or its surety) and Subcontractor (and/or its surety) shall be resolved as follows:

i) For any controversy or claim, the Parties shall participate in mediation as agreed upon between them.

In the absence of agreement with respect to the selection of the mediator or procedures for the mediation, the Parties will mediate before the American Arbitration Association pursuant to its Construction Industry Rules. The costs of the mediation shall be split evenly between the Parties.

ii) Subcontractor acknowledges that there are many potential third parties that may be a party to a dispute involving Subcontractor and ServiceMaster and, therefore, the Parties agree that any dispute not resolved by mediation shall, at the option of ServiceMaster, be resolved by binding arbitration. In the absence of agreement with respect to the selection of the arbitrator or procedures of the arbitration, if ServiceMaster elects to arbitrate, the Parties will arbitrate before the American Arbitration Association pursuant to its Construction Industry Rules. Upon notice of ServiceMaster of its election to arbitrate, Subcontractor shall dismiss any court action then pending, without prejudice, and submit to arbitration. The decision of the arbitrator(s) shall be final and binding, and judgment upon the award may be entered in any court having jurisdiction thereof.

3) Third Party Litigation or Arbitration – Should ServiceMaster and/or its surety become involved in any litigation or arbitration proceedings with Owner and/or Insurance Company or any third party involving the work covered by the Subcontract, then, upon notice by ServiceMaster, Subcontractor shall be joined as a party and be bound to the same litigation or arbitration as ServiceMaster is bound with Owner and/or Insurance Company or such third party. The election to join Subcontractor as a party to such litigation or arbitration shall be at the sole discretion of ServiceMaster, and this paragraph shall not be construed as ServiceMaster’s consent to such joinder.

4) Duty of Cooperation in Third Party Disputes – Should ServiceMaster become involved in arbitration, court or other dispute resolution proceeding with Owner and/or Insurance Company or a third party involving a claim or controversy related to the Subcontract, and Subcontractor is not a party to such proceeding, Subcontractor shall cooperate with ServiceMaster in the defense or prosecution of such claim or controversy, insofar as it relates to Subcontractor’s obligations under the Subcontract, and any arbitration or other dispute resolution proceeding between ServiceMaster and Subcontractor involving substantially the same issues shall, upon demand by ServiceMaster, be stayed, in whole or in part, pending final resolution of the claim or controversy between ServiceMaster Owner and/or Insurance Company or such third party. Nothing in this paragraph or the Subcontract shall waive or alter the obligations of Subcontractor to defend, indemnify and hold ServiceMaster harmless from claims of Owner and/or Insurance Company in any arbitration, court or other dispute resolution proceeding.

5) Continuation of Work – In the event of any dispute or controversy with ServiceMaster, another subcontractor or other third party involved with the Project, over any matter whatsoever, Subcontractor shall not cause or permit any delay or cessation of Subcontractor’s work under the Subcontract, or cause delay or disruption of the work of any other subcontractor or contractor on the Project, but shall proceed with the performance of the work in accordance with the Subcontract pending arbitration of such dispute of controversy. If Subcontractor continues to so perform pending arbitration, then ServiceMaster shall continue to make payments in accordance with the Subcontract.


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6) Dispute - Nothing in the Subcontract shall be construed to prevent ServiceMaster and Subcontractor from

resolving any dispute between them through negotiation, mediation, AGC Expedited Arbitration or other mutually agreed upon alternative dispute resolution method.

ARTICLE 26 – CORPORATE SUBCONTRACTORS AND WARRANTY OF AUTHORITY

In the event Subcontractor is a corporation, this Subcontract will be signed by the president and secretary of the corporation. The president and secretary, and any other officers or directors signing this Subcontract on behalf of the corporation, do, jointly and severally, guarantee to ServiceMaster the full and faithful performance of this Subcontract by Subcontractor, and do further agree, jointly and severally, that they shall be personally liable to ServiceMaster for the full and faithful performance of this Subcontract in every case where Subcontractor does not supply a corporate surety bond to ServiceMaster to guarantee the faithful performance hereof. Failure of ServiceMaster to request a faithful performance bond from Subcontractor shall not affect the obligation assumed by the president, secretary, officers, and directors signing this Subcontract on behalf of Subcontractor. Each Party executing this Subcontract warrants and represents that it has full power and authority to enter into this Subcontract and to bind itself to performance hereunder. Each Party further warrants and represents that the individual signing this Subcontract is an officer (if a corporate party) or a principal of the Party for which he or she signs, or has been granted or delegated all requisite power and authority to bind the Party on behalf of which he or she signs. This Subcontract is not binding on ServiceMaster unless executed by two authorized representatives of ServiceMaster. This representation and warranty of authority shall apply with equal force to each and every document executed by either Party subsequent to this Subcontract, in connection with the Subcontract Work to be performed under this Subcontract.

ARTICLE 27 – EXECUTION IN COUNTERPARTS This Subcontract may be signed by the Parties in multiple counterparts, all of which shall be taken together as a single document. A facsimile or emailed signature constitutes an original and all evidentiary objections to either, other than for authenticity of signature, are waived.

ARTICLE 28 – NO WAIVER No waiver of any Section, term, or requirement of this Subcontract shall be deemed a further or continuing waiver of such Section, term, or requirement, or any other Section, term, or requirement, and ServiceMaster’s failure to assert any right or term under this Subcontract shall not constitute a waiver of such right or term. Similarly, no waiver of any Section, term, or requirement of this Subcontract shall be deemed a waiver of any Section, term, or requirement of a past or future subcontract between ServiceMaster and Subcontractor.

ARTICLE 29 – SEVERABILITY Should any provision or part of a provision of this Subcontract be found as a matter of law to be invalid, such finding shall not have the effect of invalidating the remainder of this Subcontract and the provision or part thereof as to which such finding of invalidity is made shall be interpreted to allow only such provisions as are allowed or permitted by law; further, any provision or part of a provision found to be invalid shall be ineffective only to the extent of such invalidity without invalidating the remainder of such provision or part thereof or any of the other provisions of this Subcontract.


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I have read and fully understand this Subcontractor Agreement and I hereby agree to perform all work in accordance with the

above. I further attest that I am authorized to sign for the subcontractor listed below.

I, ______________________________________________________________________________, owner or agent

(Your Name / Title)

For: _____________________________________________________________________________

(Subcontractor Name)

__________________________________________ NAME Signature

__________________________________________ Printed Name

__________________________________________ Title

______ / ______ / ______ Date

On behalf of ServiceMaster Complete Restoration

__________________________________________ NAME Signature __________________________________________ Printed Name __________________________________________ Title ______ / ______ / ______ Date

Form W-9(Rev. August 2013)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

Pri

nt o

r ty

pe

See

Sp

ecifi

c In

stru

ctio

ns o

n p

age

2.

Name (as shown on your income tax return)

Business name/disregarded entity name, if different from above

Check appropriate box for federal tax classification:

Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶

Other (see instructions) ▶

Exemptions (see instructions):

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

Requester’s name and address (optional)

List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.

Social security number

– –

Employer identification number

–

Part II CertificationUnder penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3. I am a U.S. citizen or other U.S. person (defined below), and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Sign Here

Signature of U.S. person ▶ Date ▶

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Future developments. The IRS has created a page on IRS.gov for information about Form W-9, at www.irs.gov/w9. Information about any future developments affecting Form W-9 (such as legislation enacted after we release it) will be posted on that page.

Purpose of FormA person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, payments made to you in settlement of payment card and third party network transactions, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the

withholding tax on foreign partners’ share of effectively connected income, and

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct.

Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien,

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,

• An estate (other than a foreign estate), or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.

Cat. No. 10231X Form W-9 (Rev. 8-2013)

Form W-9 (Rev. 8-2013) Page 2

In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States:

• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity,

• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust, and

• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.

Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).

Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.

If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items:

1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.

2. The treaty article addressing the income.

3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.

4. The type and amount of income that qualifies for the exemption from tax.

5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.

Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption.

If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.

What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.

You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:

1. You do not furnish your TIN to the requester,

2. You do not certify your TIN when required (see the Part II instructions on page 3 for details),

3. The IRS tells the requester that you furnished an incorrect TIN,

4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or

5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding. See Exempt payee code on page 3 and the separate Instructions for the Requester of Form W-9 for more information.

Also see Special rules for partnerships on page 1.

What is FATCA reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W-9 for more information.

Updating Your InformationYou must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account, for example, if the grantor of a grantor trust dies.

PenaltiesFailure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.

Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.

Specific InstructionsNameIf you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name.

If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form.

Sole proprietor. Enter your individual name as shown on your income tax return on the “Name” line. You may enter your business, trade, or “doing business as (DBA)” name on the “Business name/disregarded entity name” line.

Partnership, C Corporation, or S Corporation. Enter the entity's name on the “Name” line and any business, trade, or “doing business as (DBA) name” on the “Business name/disregarded entity name” line.

Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulation section 301.7701-2(c)(2)(iii). Enter the owner's name on the “Name” line. The name of the entity entered on the “Name” line should never be a disregarded entity. The name on the “Name” line must be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on the “Name” line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the “Business name/disregarded entity name” line. If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.

Note. Check the appropriate box for the U.S. federal tax classification of the person whose name is entered on the “Name” line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate).

Limited Liability Company (LLC). If the person identified on the “Name” line is an LLC, check the “Limited liability company” box only and enter the appropriate code for the U.S. federal tax classification in the space provided. If you are an LLC that is treated as a partnership for U.S. federal tax purposes, enter “P” for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter “C” for C corporation or “S” for S corporation, as appropriate. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the “Name” line) is another LLC that is not disregarded for U.S. federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the “Name” line.

Other entities. Enter your business name as shown on required U.S. federal tax documents on the “Name” line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the “Business name/disregarded entity name” line.

ExemptionsIf you are exempt from backup withholding and/or FATCA reporting, enter in the Exemptions box, any code(s) that may apply to you. See Exempt payee code and Exemption from FATCA reporting code on page 3.


Exempt payee code. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.

Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding.

The following codes identify payees that are exempt from backup withholding:

1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)

2—The United States or any of its agencies or instrumentalities

3—A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities

4—A foreign government or any of its political subdivisions, agencies, or instrumentalities

5—A corporation

6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States

7—A futures commission merchant registered with the Commodity Futures Trading Commission

8—A real estate investment trust

9—An entity registered at all times during the tax year under the Investment Company Act of 1940

10—A common trust fund operated by a bank under section 584(a)

11—A financial institution

12—A middleman known in the investment community as a nominee or custodian

13—A trust exempt from tax under section 664 or described in section 4947

The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13.

IF the payment is for . . . THEN the payment is exempt for . . .

Interest and dividend payments All exempt payees except for 7

Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012.

Barter exchange transactions and patronage dividends

Exempt payees 1 through 4

Payments over $600 required to be

reported and direct sales over $5,0001Generally, exempt payees

1 through 52

Payments made in settlement of payment card or third party network transactions

Exempt payees 1 through 4

1 See Form 1099-MISC, Miscellaneous Income, and its instructions.2 However, the following payments made to a corporation and reportable on Form

1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency.

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements.

A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)

B—The United States or any of its agencies or instrumentalities

C—A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities

D—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Reg. section 1.1472-1(c)(1)(i)

E—A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1(c)(1)(i)

F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state

G—A real estate investment trust

H—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940

I—A common trust fund as defined in section 584(a)

J—A bank as defined in section 581

K—A broker

L—A trust exempt from tax under section 664 or described in section 4947(a)(1)

M—A tax exempt trust under a section 403(b) plan or section 457(g) plan

Part I. Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below.

If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN.

If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.

Note. See the chart on page 4 for further clarification of name and TIN combinations.

How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676).

If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.

Note. Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.

Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.

Part II. CertificationTo establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if items 1, 4, or 5 below indicate otherwise.

For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the “Name” line must sign. Exempt payees, see Exempt payee code earlier.

Signature requirements. Complete the certification as indicated in items 1 through 5 below.

1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification.

2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form.

3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.

4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).

5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification.


What Name and Number To Give the RequesterFor this type of account: Give name and SSN of:

1. Individual The individual2. Two or more individuals (joint

account)The actual owner of the account or, if combined funds, the first individual on the account 1

3. Custodian account of a minor (Uniform Gift to Minors Act)

The minor 2

4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law

The grantor-trustee 1

The actual owner 1

5. Sole proprietorship or disregarded entity owned by an individual

The owner 3

6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1.671-4(b)(2)(i)(A))

The grantor*

For this type of account: Give name and EIN of:

7. Disregarded entity not owned by an individual

The owner

8. A valid trust, estate, or pension trust Legal entity 4

9. Corporation or LLC electing corporate status on Form 8832 or Form 2553

The corporation

10. Association, club, religious, charitable, educational, or other tax-exempt organization

The organization

11. Partnership or multi-member LLC The partnership12. A broker or registered nominee The broker or nominee

13. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments

The public entity

14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1.671-4(b)(2)(i)(B))

The trust

1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.

2 Circle the minor’s name and furnish the minor’s SSN.

3 You must show your individual name and you may also enter your business or “DBA” name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.

4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 1.

*Note. Grantor also must provide a Form W-9 to trustee of trust.

Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.

Secure Your Tax Records from Identity TheftIdentity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund.

To reduce your risk:

• Protect your SSN,

• Ensure your employer is protecting your SSN, and

• Be careful when choosing a tax preparer.

If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.

If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.

For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance.

Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.

Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.

The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts.

If you receive an unsolicited email claiming to be from the IRS, forward this message to [email protected]. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: [email protected] or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT (1-877-438-4338).

Visit IRS.gov to learn more about identity theft and how to reduce your risk.

Privacy Act NoticeSection 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.

CONTRACTORS STATE LICENSE BOARD STATE OF CALIFORNIA 9821 Business Park Drive, Sacramento, California 95827 Governor Edmund G. Brown Jr. Mailing Address: P.O. Box 26000, Sacramento, CA 95826

800-321-CSLB (2752) www.cslb.ca.gov ▪ CheckTheLicenseFirst.com

Exemption from Workers’ Compensation

Before the Cont

ractors State License Board (CSLB) can issue a new license or reinstate, reactivate, or renew an existing license, the applicant or licensee must have on file a Certificate of Workers’ Compensation Insurance or a Certificate of Self-Insurance issued by the Director of Industrial Relations, or must obtain an exemption by completing and submitting this form.

To be exempt from workers’ compensation, an applicant or licensee must submit this form to CSLB, certifying under penalty of perjury that he or she does not employ anyone in a manner that is subject to the workers’ compensation laws of California. (See Business and Professions Code Section 7125.)

DO NOT SUBMIT THIS FORM IF: You have an inactive license. The license qualifier is a Responsible Managing Employee (RME). You hold a C-39 Roofing classification – all contractors with a C-39 Roofing classification are required by Section 7125 to have a

Certificate of Workers’ Compensation Insurance or a Certificate of Self-Insurance on file with the Board. Contractors with a C-39 Roofing classification are not eligible for exemption from workers’ compensation.

You have employees.

For exemption from workers’ compensation, complete all of the requested information in Section 1, check only one of the boxes in Section 2, and date and sign the form in Section 3.

Please type or print neatly and legibly in black or dark blue ink.

SECTION 1 – REQUIRED BUSINESS NAME AND ADDRESS Business Name (as it currently appears on CSLB records) License or Application Fee Number Business Mailing Address (number/street or P.O. box) City State Zip Code

Business Street Address (number/street only – NO P.O. boxes) City State Zip Code

Business Phone Number Business Fax Number Business E-mail Address

( ) ( )

□ Check this box if the address shown above is new. CSLB will update your license / application business address of record.

SECTION 2 – REQUIRED CHECK BOX

YOU MUST CHECK ONLY ONE OF THE BOXES BELOW.

□ I do not employ anyone in the manner subject to the workers’ compensation laws of California. OR □ I am an out-of-state contractor, and I do not hire employees who reside in California. (You must provide a certificate of insurance from your

workers’ compensation insurance carrier in your home state.)

SECTION 3 – REQUIRED SIGNATURE I certify under penalty of perjury under the laws of the State of California that the information provided on this exemption statement is true and accurate. I understand that, upon employing anyone in a manner that is subject to the workers’ compensation laws of the State of California, the claim of exemption executed under this form will no longer be valid. I also understand that, as soon as I employ anyone subject to the California’s workers’ compensation laws, I must obtain a Certificate of Workers’ Compensation Insurance, submit that certificate to CSLB within 90 days of its effective date, and continuously maintain the coverage provided by the certificate in accordance with the law. I further understand that failure to comply with this requirement is grounds for disciplinary action. (The definition of “perjury” is telling a lie while under oath.)

FALSIFICATION OF ANY DOCUMENT IS GROUNDS FOR DISCIPLINARY ACTION.

Date Signature of Contractor (Owner, Partner, or Officer) Printed Name of Contractor (Owner, Partner, or Officer)

NOTICE ON COLLECTION OF PERSONAL INFORMATION CSLB collects the personal information requested on this form as authorized by Business and Professions Code Section 30. CSLB uses this information to identify and evaluate applicants for licensure, issue and renew licenses, and enforce licensing standards set by law and egulation. Submission of the requested information is mandatory. CSLB cannot consider this Exemption from Workers Compensation form unless you provide all of the requested information. You may review the records maintained by CSLB that contain your personal information, as permitted by the Information Practices Act. CSLB makes every effort to protect the personal information you provide us; however, it may be disclosed in response to a Public Records Act request as allowed by the Information Practices Act; to another government agency as required by state or federal law; or in response to a court or administrative order, a subpoena, or a search warrant. This application contains an applicant authorization for the Franchise Tax Board to disclose to CSLB any outstanding final liabilities for the purpose of administering Business and Professions Code Section 7145.5. For more information on the Information Practices Act, visit the Office of Privacy Protection’s website at www.privacy.ca.gov.

*

WC

-

EXEMPT

* 13L-50 (rev. 4/11)

FOR CSLB USE ONLY

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