vendor form

I (We), "The Vendor", hereby acknowledge and warrant that Vendor has reviewed the Florida Statutes which govern the requirements for Workers' Compensation coverage and has either (i) provided proof of coverage, (ii) received an executed exemption certificate from the proper authorities within the State of Florida or (iii) determined that Vendor’s work to be performed is exempt from the requirement for such coverage. If proof of coverage is not provided, you may rely upon Vendor’s representation that you have no obligation under the current statutes to either require Vendor to produce proof of coverage or to provide coverage on Vendor’s behalf. Vendor agrees to fully indemnify you, your officers, directors, managers, employees, agents and all related entities, from any and all claims filed for any such occurrence that would be covered under the provisions of Workers’ Compensation insurance if Vendor had obtained such coverage and, in such event, Vendor waives any rights against you and your insurer for any damages to Vendor or Vendor’s partners, shareholders, employees, or other persons working by, through, under or on behalf of Vendor or otherwise allowed to be on your property in the pursuit of work Vendor is doing for you. Vendor warrants that Vendor will immediately notify you of termination of coverage or any change in Vendor’s warranted status as legally exempt from Workers’ Compensation coverage and will obtain such coverage immediately upon becoming required to have it. This Agreement and Warranty is intended to protect you and your officers, directors, managers, employees, agents, and all related and associated entities, for all work Vendor may do for all such persons and entities until such time as Vendor provides you, or the applicable entity, with written notice to the contrary. This Agreement and Warranty is knowingly and voluntarily entered into by Vendor and Vendor fully understands its terms, conditions and representations.