Professional Services Agreement - Additional …

1 Page1of 2 Additional ServicesAddendumVF-604 Rev. 13 11/04/16 Professional Services Agreement - Additional ServicesAddendumContractorBy executing this addendumyouare confirming the addition ofthe selected service(s) below foryourcompany. Upon receipt of this completed addendum ,your company will be billedbased onthe pricingtierselectedby your company(if applicable)and in accordance with the pricing structure outlined in the currentversion of the Professional ServicesAgreement (PSA), Exhibit A. Please note that your companyis boundby all terms and conditions of the Agreement outlined in the original PSA signed by your Services beloware prepaid annuallyand renew automatically unless written noticeto terminate serviceisprovided to Veriforce.

2 Any overages incurred for users beyond the selected tier(if applicable)will be billedin arrears,and the prepaid amount for subsequent year(s) will be based on the prior year s actual number fee amounts are in : Enter your company name, initial next to each desired service item to be added to youraccount,select the appropriate pricingtierbased on number of users(if applicable), and completethe signaturesection on the last page. Submit your completed addendum to Veriforce for processingeither by fax to 281-715-5780 or email Training ManagementPRICEBASED ON NUMBER OF USERS(select below)Enables contractor to administer training within VeriSource, including the ability to create trainingprograms with exams/quizzes, assign trainingcourses, deliver computer-based training, track trainingprogress, manage training expirations, and capture training and testing ($100)($250)($500)($1,000)($1,500)($2,00 0)201-300301-400401-500501 10001001 +($2,500)($3,000)($3,500)($4,000)(Custom Pricing)

3 _____VeriSourceSafetyCBTL ibraryPRICEBASED ON NUMBER OF USERS(select below)Access to a library of computer-based safety training courses that help improve employees safetyawareness and address training requirements in federal OSHA general industry & ($300)($1,250)($2,500)($3,750)($5,250)($ 7,500)201-300301-400401-500501 10001001 +($9,500)($11,500)($14,500)($16,500)(Cus tom Pricing)Page2of 2 Additional ServicesAddendumVF-604 Rev. 13 11/04/16 VeriSource Pipeline Skills 101 CBT LibraryPRICEBASED ON NUMBER OF USERS(select below)Access to a library of computer-based training courses designed to help crew members whoare new tothe industry quickly build their knowledge across key areas of pipeline ($1,250)($2,500)($3,750)($5,225)($7,500) ($9,500)301-400401-500501 10001001 +($11,500)($14,500)($16,500)(CustomPrici ng)_____Elite Evaluator Program$3,000 With the purchase of this service, Veriforce will perform assessment activities to determine if theCompany and/or Evaluator(s)

4 Meet all requirementsof the Veriforce Elite Evaluator theCompany and/or Evaluator(s) meet requirements, Veriforce will award the Company and/or Evaluator(s)with an Elite status which will be reported in VeriSource as long as the Company and/or Evaluator(s)are in good standing as defined in the Veriforce Elite Evaluator : Evaluators who wish tobecome Elite must submit the Elite Evaluator Registration Form available in VeriSource. Minimum one (1) EliteEvaluator required per charges for Additional Services :$Veriforce,LLCANew Mexico limitedliabilitycompanyContractorCompany VeriforceRepresentativeSignatureContract or RepresentativeSignatureVeriforce AddressforNotice:PrintedNameAddress:1922 1 I-45 South, Internal UseOnlyEffective Date/AddendumReceived:GP ID:BANK ROUTINGNUMBERBANK ACCOUNTNUMBER Card Number:Expiration Date:Customer s Name as it appears on credit card:Customer Signature:Email address for receipt:9 Digit Routing Number:Bank Account Number:Bank Name:Customer s Name as it appears on bank account.

5 Bank Account Type:Customer Name Printed:Customer Signature:Email address for receipt:Payment Authorization FormElectronic Check:(for based accounts only)I, authorize Veriforce LLC to charge my bank/credit card account listed below for the amount of $ for the following Services :Select PSA Option Select Training Management OptionSelect Safety CBT Library Option Select Elite Evaluator OptionSelect Pipeline Skills 101 CBT Library Optionon Date:Credit Cards:Completed form should be emailed to or faxed to 281-715-5780 to ensure timely | Page 1 of 1 Rev 2 - 11/01 CHECKS