120 Water - Lead Service Line Inventory - November 2022CITY OF SANDY, OREGON
PROFESSIONAL SERVICES AGREEMENT
The City of Sandy, Oregon (“City”) and 120 Water Audit, Inc. (“Consultant”) enter into this
Professional Services Agreement (“Agreement”) on November 15, 2022 (“Effective Date”).
WHEREAS, City and Consultant believe it in their respective and mutual interests to enter into a
written Agreement setting out their understandings concerning Consultant’s provision for
consulting services as described in the Scope of Work in Exhibit A.
Now, therefore, in consideration of the mutual promises and covenants contained herein, the
sufficiency of which is acknowledged by the parties, the parties agree as follows.
1. Term
This Agreement shall run from the Effective Date through and including the date when the
work under the last active scope of work or order form entered into by the parties is
completed, unless sooner terminated under the provisions of this Agreement or extended
through an amendment.
2. Consultant's Service
The scope of Consultant's services (“Scope of Work”) and time of performance under this
Agreement are set forth in Exhibit “A”. All provisions and covenants contained in Exhibit A
are incorporated by reference and are a part of this Agreement as if fully set forth. Any
conflict between this Agreement and Exhibit A shall be resolved first in favor of this written
Agreement. Consultant will, in the rendering of its services to City, use commercially
reasonable efforts and due diligence and provide such personnel as are necessary to
successfully provide the services covered under this Agreement. The parties may only change
the scope of services through an amendment.
3. Consultant Identification
Consultant's employer identification number, as designated by the Internal Revenue Service,
is 81-1714517.
4. Compensation
City agrees to pay Consultant $15,820 for the work agreed upon for the project as stated in the
Scope of work in Exhibit A, and as agreed upon in any future Scope of Work documents
entered into by the parties which shall be effective only if reduced to writing and signed by
authorized agents of City and Consultant.
5. Primary Staff Contact
City's Primary Staff Contact is AJ Thorne or Thomas Fisher. Consultant's Primary Staff
Contact is Logan Turner. Each party shall give the other written notification of any change in
their respective Primary Staff Contact.
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City of Sandy and 120 Water DMS 24098018.46. Project Information
Consultant agrees to share all project information relevant to the City of Sandy, to fully
cooperate with all corporations, firms, contractors, governmental entities, and
personsinvolved in or associated with the project. No information, news, or press releases
related to the project shall be made to representatives of newspapers, magazines, television
and radio stations, or any other news medium without the prior authorization of City's
Primary Staff Contact.
7. Duty to Inform
Consultant shall give prompt written notice to City's Primary Staff Contact if, at any time
during the performance of this Agreement, Consultant becomes aware of actual or potential
problems, faults or defects in the project, any material nonconformity with the Agreement, or
with any federal, state, or local law, rule or regulation, or has any objection to any decision or
order made by City. Any delay or failure on the part of City to provide a written response to
Consultant shall constitute neither agreement with nor acquiescence in Consultant's statement
or claim and shall not constitute a waiver of any of City's rights.
8. Consultant is Independent Contractor
Consultant is an independent contractor for all purposes and shall be entitled to no
compensation other than the compensation expressly provided by this Agreement. Consultant
hereby expressly acknowledges and agrees that as an independent contractor, Consultant is
not entitled to indemnification by the City or the provision of a defense by the City under the
terms of ORS 30.285. This acknowledgment by Consultant shall not affect his/her/its
independent ability (or the ability of his/her/its insurer) to assert the monetary limitations
found at ORS 30.270, the immunities listed at ORS 30.265 or other limitations affecting the
assertion of any claim under the terms of the Oregon Tort Claims Act (ORS 30.260 to
ORS30.300).
9. Overtime
Any person employed on work under this Agreement, other than a person subject to being
excluded from the payment of overtime pursuant to either ORS 653.010 to 653.261 or 29
USC§201 to 209, shall be paid at least time and a half for all overtime worked in excess of 40
hours in any one week.
10. Indemnity and Insurance
i.Indemnity: Consultant shall hold City harmless from and indemnify and defend City for
any and all liability, settlements, loss, costs, and expenses in connection with any action,
suit, or claim by a third party to the extent resulting or allegedly resulting from
Consultant's acts, omissions, activities or services in the course of performing this
Agreement.
ii.Liability Insurance: Consultant shall maintain occurrence form commercial general
liability and automobile liability insurance for the protection of Consultant, City, its
Councilors, officers, agents and employees. Coverage shall include personal injury, bodily
injury (including death) and broad form property damage, including loss of use of
property, occurring in the course of or in any way related to Consultant's operations, in an
amount not less than Two Million dollars ($2,000.000.00) combined single limit per
occurrence. Such insurance shall name City as an additional insured.
iii.Errors & Omissions Insurance: Consultant shall maintain professional liability insurance
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City of Sandy and 120 Water DMS 24098018.4
in the amount of not less than $2,000,000 per claim. Consultant shall keep in force the
professional liability policy for at least 24 months after the expiration of the Agreement
with City. In any case, Consultant shall notify City in the event of a cancellation or
reduction in limits. Unless such cancellation or reduction is immediately cured by
Consultant, such cancellation or reduction constitutes a breach of this Agreement.
iv.Workers' Compensation Coverage: Consultant certifies that Consultant has qualified for
State of Oregon Workers' Compensation coverage for all Consultant's employees who are
subject to Oregon's Workers' Compensation statute, either as a carrier-insured employer as
provided by ORS 656.407, or as a self-insured employer. Consultant shall provide to City
within ten (10) days after Agreement award a certificate of insurance evidencing overage
of all subject workers under Oregon's Workers' Compensation statutes insured by an
insurance company satisfactory to City, if any. The certificate and policy shall indicate
that the policy shall not be terminated by the insurance carrier without thirty (30) days'
advance written notice to City. A copy of the certificate of self-insurance issued by the
State shall be provided to City if the Consultant is self-insured.
v.Certificates: Consultant shall furnish City certificates evidencing the date, amount, and
type of insurance required by this Agreement. All policies will provide for not less than
thirty (30) days' written notice to City before they may be canceled.
vi.Primary Coverage: The coverage provided by insurance required under this Agreement
shall be primary, and any other insurance carried by City shall be excess.
11. Intentionally Omitted
12. Law of Oregon
The Agreement shall be governed by the laws of the State of Oregon, without regard to
conflict of laws principles. Venue shall be in Clackamas County, Oregon.
13. Errors
Consultant shall perform such additional work as may be necessary to correct errors in the
work required under this Agreement without undue delays and without additional cost.
14. Additional Work
Only the City Manager, Primary Staff Contact, or the Primary Staff Contact’s representative
may authorize additional work. Failure of Consultant to secure authorization for additional
work shall constitute a waiver of all right to adjustment in the Agreement price or Agreement
time due to such unauthorized extra work and Consultant thereafter shall be entitled to no
compensation whatsoever for the performance of such work.
15. Successors and Assignments
i.Both City and Consultant bind themselves and any partner, successor, executor,
administrator, or assign to this Agreement.
ii.Neither City nor Consultant shall assign or transfer their interest or obligation hereunder in
this Agreement without the written consent of the other party, provided that consent is not
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City of Sandy and 120 Water DMS 24098018.4
required in the event a party assigns, transfers, or conveys substantially all its business
assets or equity and provided that the assignee/transferee provides the other party, upon
such other party’s request, with reasonable assurances of performance of its obligations
under this Agreement. Any assignment, transfer, or subcontract attempted in violation of
this subparagraph shall be void.
16. Records
i.Consultant shall retain all books, documents, papers, and records that are directly pertinent
to this Agreement for at least three years after City makes final payment on this
Agreement and all other pending matters are closed.
ii.Consultant shall allow City (or any of its authorized representatives) to audit, examine,
copy, take excerpts from or transcribe any books, documents, papers, or records that are
subject to the foregoing retention requirement, it be agreed that all information provided
to or obtained by City or its representatives pursuant to this Section 16 shall be
considered Consultant’s confidential information and maintained as such during this
Agreement and after any expiration or termination, notwithstanding City’s obligations
under the Oregon public records law.
17. Breach of Agreement
i.Consultant shall remedy any breach of this Agreement within thirty (30) days after City
notifies Consultant in writing of the breach . If Consultant fails to remedy a breach in
accordance with this paragraph, City may terminate that part of the Agreement affected
by the breach upon written notice to Consultant, .
ii.If the breach is material and Consultant fails to remedy the breach in accordance with this
paragraph, City may declare Consultant in default and pursue any remedy available for a
default.
iii.Pending a decision to terminate all or part of this Agreement, City unilaterally may order
Consultant to suspend all or part of the services under this Agreement. If City terminates
all or part of the Agreement pursuant to this paragraph, Consultant shall be entitled to
compensation only for services rendered prior to ten (10) days after receipt of such order
to suspend or the date of termination, whichever is later, but not for any services rendered
after City ordered suspension of those services. If City suspends certain services under
this Agreement and later orders Consultant to resume those services, Consultant shall be
entitled to reasonable damages actually incurred, if any, as a result of the suspension.
iv.To recover amounts due under this paragraph, City may withhold from any amounts owed
by City to Consultant.
18. Mediation/ Trial without a jury
Should any dispute arise between the parties to this Agreement concerning their respective
obligations of either or the terms hereof, it is agreed that such dispute will be submitted to a
mediator prior to any litigation and the parties hereby expressly agree that no claim or dispute
arising under the terms of this Agreement shall be resolved other than first through mediation
and only in the event said mediation efforts fail, through litigation. Any litigation arising
under
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City of Sandy and 120 Water DMS 24098018.4
or as a result of this Agreement shall be tried to the court without a jury. Each party agrees to
be responsible for payment of its own professional fees, including attorneys’ fees in both
mediation and litigation.
19. Termination for Convenience
The City may terminate all or part of this Agreement at any time for its own convenience by
providing at least thirty (30) days’ prior written notice to Consultant. Upon termination under
this paragraph, Consultant shall be entitled to compensation for all services rendered prior to
actual notice of the termination or the receipt of the City's written notice of termination,
whichever is earlier, plus Consultant's reasonable costs actually incurred in closing out the
Agreement. Consultant is not entitled to special or consequential damages upon termination,
including lost profits. The City will not be entitled to a refund of any prior paid amounts.
20. Intentionally Omitted
21. Payment for Labor or Material
Consultant shall make payment promptly, as due, to all persons supplying to Consultant labor
or material for the prosecution of the work provided for in this Agreement. (ORS 279B.220)
22. Contributions to the Industrial Accident Fund
If applicable, Consultant shall pay all contributions or amounts due the Industrial Accident
Fund from Consultant incurred in the performance of this Agreement and shall ensure that all
subcontractors pay those amounts due from the subcontractors. (ORS 279B.220)
23. Income Tax Withholding
If applicable, Consultant shall pay to the Oregon Department of Revenue all sums withheld
from employees pursuant to ORS 316.167. (ORS279B.220)
24. Payment of Claims by the City
If Consultant fails, neglects, or refuses to make prompt payment of any claim for labor or
services furnished to Consultant or a subcontractor by any person in connection with this
Agreement as the claim becomes due, the City may pay the claim to the person furnishing the
labor or services and charge the amount of the payment against funds due or to become due to
Consultant pursuant to this Agreement. The City's payment of a claim under this Paragraph
shall not relieve Consultant or Consultant's surety, if any, from responsibility for those claims.
25. Hours of Labor
Consultant shall pay employees for overtime work performed under the terms of this
Agreement in accordance with ORS 653.010 to ORS 653.261 and the Fair labor standards
Act of 1938. (29 USC §§ 201 et. seq.)
26. Workers’ Compensation
Consultant is a subject employer that will comply with ORS 656.017. Consultant warrants that
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City of Sandy and 120 Water DMS 24098018.4
all persons engaged in contract work and subject to the Oregon Workers’ Compensation law
are covered by a workers’ compensation plan or insurance policy that fully complies with
Oregon law. Consultant shall indemnify City for any liability incurred by City as a result of
Consultant's breach of the warranty under this Paragraph. (ORS 279B.230)
27. Medical Care for Employees
Consultant shall make payment of all sums to any person, co-partnership, association or
corporation, furnishing medical, surgical and/or hospital care incident to the sickness or injury
of Consultant's employee(s), all sums which Consultant agrees to pay for such services and all
monies and sums which Consultant collected or deducted from the wages of employees
pursuant to any law or contract for the purpose of providing or paying for such service. (ORS
279B.230)
28. Modification
To be effective, any modification of the provisions of this Agreement shall be reduced to
writing and signed by authorized agents of City and Consultant.
29. No Waiver of Legal Rights
A waiver by a party of any breach by the other shall not be deemed to be a waiver of any
subsequent breach.
30. Integration
This Agreement and all Exhibits (including the Master Services Agreement referenced in the
Order Form attached hereto as Exhibit B) contains the entire agreement between City and
Consultant and supersedes all prior written or oral discussions or agreements regarding the
same subject. The background recitals form a material part of this Agreement.
[SIGNATURES ON FOLLOWING PAGE]
Page 6 – Personal Services Agreement between
City of Sandy and 120 Water DMS 24098018.4
City of Sandy, Oregon
Digitally signed by AJ Thorne
DN: C=US,AJ Thorne O=City of Sandy, CN=AJ Thorne
____E=ajthorne@cityofsandy.com,
Date: 2022.11.14 15:56:56-08'00'
AJ Thorne
Assistant Public Works Director
Consultant:120 Water Audit, Inc.
By
Name:
Title:
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City of Sandy and 120 Water DMS 24098018.4
EXHIBIT A
SCOPE OF WORK
EXHIBIT B
ORDER FORM
Matthew Boes
Director of Sales
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City of Sandy and 120 Water DMS 24098018.4
Lead Service Line Inventory Scope Of Work
This Scope of Work is incorporated in the agreement between 120 Water Audit, Inc., and City of Sandy,
OR Deliverables : The “Works,” as defined in the Agreement, comprise the deliverables stated in this
SOW for each phase.
Goal: Define and execute a plan to comply with the revised Lead and Copper Rule, including developing
an inventory, categorized by customer address, for City of Sandy, OR with fully known SL material
information. Available in 120Water Platform and ArcGIS-compatible format (via 120Water-Esri
Connector), and provide water quality lead and copper sampling services.
Inventory Development Methodology:
There are 7 separate phases to developing a full LSLI. They are:
1) Program Start and Customer Alignment
2) Data Investigation and Submission
3) Data Analysis
4) Preliminary Findings and Software Alignment
5) Software Import and Training
6) LSLI Verification Strategy
7) LSLI Verifications
Further information on each of these phases, along with a general timetable to complete, can be found
below.
Phase 1: Program Start and Customer Alignment (1-2 weeks) | The purpose of this program stage is for
the 120Water and City of Sandy, OR teams to initiate the lead service line inventory (LSLI) program and
align on program expectations
● Customer Kick-Off Meeting: the 120Water team will host an introductory meeting to
establish the cross-functional Program Team and confirm roles and responsibilities. The session
will also establish the program approach including success metrics and project timelines, and the
cadence of program reviews, client updates, and any additional City of Sandy, OR goals and
expectations
● Deliverable(s): Document containing metrics, timelines, and roles and responsibilities.
Phase 2: Data Investigation and Submission (4-6 weeks) | The purpose of this program stage is for the
120Water team to identify, review, document, and collaboratively understand the existing data source(s)
and systems.
● Data Investigation Call with 120Water LSLI Lead Program Consultant: The 120Water
team will schedule a guided review meeting with City of Sandy, OR to identify sources of data the
120Water team can use to build out a preliminary lead service line inventory. Common data
sources include:
○ GIS records
○ Billing system records
○ Work order system record
○ Paper reports, tap cards, as-builts, etc.
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○ Recent capital projects
● Data Request: After the Data Investigation Call, the LSLI Lead Program Consultant will
submit a formal data request to City of Sandy, OR. The data request will outline the specific
sources of data the 120Water team will need to analyze in order to identify all service locations,
identify or rule-out sources of lead, and prioritize and strategize for lead service line inventory and
replacement efforts.
● Data Submission: 120Water will review all submitted data sources. Once all data is
submitted, the 120Water team will determine the best analysis approach to bring the data
together into a single data set that reflects all service line locations and associated attributes.
○ ESRI Partnership Solution: Since City of Sandy, OR will want the ability to
visualize data in ArcGIS Online (AGOL), 120Water will set up a City of Sandy, OR
specific AGOL environment for data submission. 120Water will update the AGOL
environment with preliminary inventory findings and continued inventory updates from the
120Water platform, as City of Sandy, OR progresses through their lead service line
inventory program
● Deliverable(s): Data requests, data analysis plan options
Phase 3: Data Analysis (4-8 weeks) | The purpose of this program stage is to combine all submitted data
to develop a preliminary, location-based lead service line inventory that includes EPA complaint service
line material categorizations for all identified service lines. The aim is to use existing client data to identify
locations, and use the data to rule out potential sources of lead.
● Initiate Analysis: The 120Water data analysis team will conduct a thorough review of the
submitted data, to ensure all data fields are understood and data integrity is maintained.
● Build Records-Based Inventory: The 120Water data analysis team will clean and combine
all appropriate data sources into a single service line inventory dataset. The final dataset in this
stage will include service line locations and material type categorizations for each identified
service line in the distribution network, as well as all associated location and service line
attributes.
● Note: Should City of Sandy, OR have records of lead service lines within the system, City
of Sandy, OR may then choose to use a data science driven selection approach to identify a
statistically-driven selection of locations (less than 400 service connections)for physical field
verification (not included in scope). 120Water will use the verification results as the basis for lead
service line probability predictions. This approach may require additional investment from a City
of Sandy, OR chosen (or 120Water Service Partner) field services firm to execute
potholing/hydrovacing/home inspections.
● Deliverable(s): Dataset containing the information described above in this phase.
Phase 4: Preliminary Findings and Software Alignment (2-4 weeks) |The purpose of this program stage
is to deliver the results of the preliminary inventory, and gather any additional feedback from the client to
support inventory development—both in terms of reviewing the inventory itself and ensuring the 120Water
platform sets the client up for success in long-term inventory management.
● Preliminary Findings Session: The 120Water team will meet with the City of Sandy, OR to
deliver the preliminary inventory findings. The session will cover a discussion of service line
locations, material type associations, the number of service lines the 120Water team was able to
categorize as non-lead, geographic trends, etc.
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○ Data Verification: Using the findings the 120Water team will work with City of
Sandy, OR to determine if additional data is required to inform the inventory.
○ Software Alignment: During the session, the 120Water team will propose the
methodology for customizing the 120Water platform to meet the City of Sandy, OR needs
(e.g., customization data fields, location and service line identifiers, prioritization set-up,
etc.).
● Additional Data Incorporation: If the City of Sandy, OR submits additional data to be
incorporated into the lead service line inventory, 120Water will process the data and integrate the
new information into the preliminary inventory.
● Deliverable(s): Report of preliminary inventory findings, configuration documentation.
Phase 5: Software Import and Training (2-4 weeks) | The purpose of this program stage is to introduce
City of Sandy, OR to their data in the software, and train the City of Sandy, OR team on how best to use
the software for continued inventory management.
● Software Configuration: Setup and configure 120Water platform software account and
setup user(s) account(s)
● Inventory Software Import: Import the prepared data (and/or)use client’s existing records
into the 120Water software
○ Note: If City of Sandy, OR does elect to use the Lead Service Line Probability
Finder (predictive model), the 120Water data analysis team will run the model to assess
service lines that have the highest probability of containing lead. The preliminary
inventory will need to contain sufficient data on SL locations in order to run the model. If
the preliminary inventory does not contain the necessary data, 120Water will determine
the best path to getting enough observations with City of Sandy, OR.
● Software Training: the 120Water team will train City of Sandy, OR user(s) on the
120Water software platform using City of Sandy, OR’s data. During this session, the 120Water
team and the client will discuss current data systems and processes and provide guidance on
using 120Water platform for long-term LSL management
● City of Sandy, OR specific 120Water-AGOL environment.
● Deliverable (s): Supporting documentation from training sessions
Phase 6: Lead Service Line Inventory Verification Strategy (1-2 Weeks) | The purpose of this program
stage is to strategize with City of Sandy, OR on how best to proceed with verifying the material types of
service lines that are categorized as Unknown in the lead service line inventory.
● Establish the Prioritization Team: the 120Water team will meet with the client to determine
the key decision-maker who will own the prioritization and scheduling
● Hold Prioritization and Verification Workshop: The 120Water team and the Prioritization
Team will work through inventory findings, prioritization metrics, geographic considerations,
neighborhood information, and other details to define the method for organizing ongoing inventory
efforts. In addition, both teams will discuss and strategize verification methods that are best
suited to support inventory efforts. Additional 120Water offerings include:
○ Customer LSLI Postcard or Letter Survey Campaigns
○ Lead Check Swab Kits + Customer LSLI Postcard Survey Campaigns
○ Physical Field Validation Checks
○ Sampling
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● Initiate and Continue Inventory Efforts: City of Sandy, OR will continue leveraging
120Water software to keep the LSLI updated.
● Continuous Inventory Review: Review the LSLI for compliance throughout the inventory
process to ensure the lead service line inventory meets state and federal requirements
● Deliverable(s): Validation plan document
Phase 7: Lead Service Line Inventory Verification (varies) | The purpose of this program stage is to
execute on the strategies decided upon during the Verification Strategy phase. The City of Sandy, OR
team will have the option to use 120Water or 120Water Partner services to execute the chosen
Verification Strategies, or perform those methods internally. In either case the 120Water Platform will
serve as the database of record for all Service Line material updates, and the Platform will deliver that
data back to City of Sandy, OR’s GIS via the 120Water-Esri Connector.
● Deliverable(s): data produced by the platform.
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Postcard Survey Communications Module:
The Customer Surveys can be co-developed alongside the designated City of Sandy, OR team member
and other staff representatives. Customer Surveys typically include a City of Sandy, OR Branded
Envelope, Customer Survey for hard copy completion with QR Code for Digital completion and prepaid
return envelope.
All customer surveys will be scheduled, fulfilled and shipped directly through the 120Water Platform. All
stages of the lifespan will be tracked within the platform in real time, documenting/time stamping the date
customer surveys were ordered, shipped, delivered, and completed.
The process is as follows:
Step 1:Client Kick-Off Meeting - In this meeting we will introduce your designated team and prepare youfor the launch in the program.
Step 2:Data implementation Meeting - For this step, the process is identifying where customer address
information for all applicable residents lives and providing the 120Water team with that information to setup the platform.
Step 3:Design and Upload the postcard survey template and then iterate on any missing information.
Step 4:Get the postcards ready for delivery.
Step 5:Implementation of the Communications Module. We will be tracking each postcard survey in the
platform from delivery to shipped to return
Step 6:Identify any “return to sender” or undeliverable addresses and review the data
Step 7:Track results as they are being inputted by residents
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City of Sandy - OR - LSLI, Comms
City of Sandy - OR
39250 PIONEER BLVD
MIKE WALKER
Sandy, OR 97055
United States
Jenny Coker
jcoker@ci.sandy.or.us
+15036686927
Reference: 20221019-082139232
Quote created: October 19, 2022
Quote expires: February 28, 2023
Quote created by: Liz Johns
liz.johns@120water.com
Comments from Liz Johns
Contract start date at time of signature.
Unit Pricing for Veri cation Techniques:
- 5 Bottle 1L Kits, $66.09
- 2 Bottle 1L Lab Analysis, $36.36
- 3M Lead Check Swab with Magnet Validation Kit, $26.43
- Postcard Surveys, $1.75
Products & Services
Item Name & Description Unit Price Quantity Term
(months)
EXHIBIT A
Item Name & Description Unit Price Quantity Term
(months)
Pro - Public Water System $6,820.00
/ year
1 24
Implementation $1,500.00
/ year
1
Professional Services (Assist) $2,500.00
/ year
3 24
Subtotals
Annual subtotal $15,820.00
Total $15,820.00
Annual subscription PWS Pro package to manage programs and
data. Unlimited users
Setup, Con guration and Guided Web Training of the 120Water
Account
Discrete tappable speci cs under each scope area (block of 20
hours)
Purchase terms
Net 30 billing.
Invoice Terms:
Billing Street Address:
Billing City:
Billing State:
Billing Zip Code:
Billing Country:
Billing Notes (if applicable):
This Order Form, together with the Master Services Agreement available
at https://120water.com/master-services-agreement/ (the “MSA”), shall become a legally binding
contract upon the earlier of (a) the date both parties execute the Order Form or (b) the date
Customer initially began using the Services. Any capitalized word not otherwise de ned in this
Order Form shall have the same meaning as set forth in the MSA.
120Water may reject this Order Form if: (1) the signatory below does not have the authority to
bind Customer to this Order Form, (2) changes have been made to this Order Form (other than
completion of the purchase order information and signature block), or (3) the requested purchase
order information or signature is incomplete or does not match our records or the rest of this
Order Form. Subscriptions are non-cancelable before their end of the Term.
Signature
Signature Date
Printed name
Countersignature
Countersignature Date
Printed name
Questions? Contact me
Liz Johns
liz.johns@120water.com
120Water
250 S Elm St
Zionsville, IN 46077
US
Matthew Boes
11/15/2022