Selecting and Maintaining Vendors

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[Insert name, address, phone number, email, and fax for Vendor]

Certification of proper handling and management of electronics equipment received from Free Geek, Inc. on [insert date materials were received by vendor/broker]:

This statement certifies that the electronics equipment sent by your organization for recovery and recycling has been transported and unloaded at [provide company name and address where materials are sent to be handled/brokered]. [Name of vendor/broker] has taken ownership and responsibility for this material. Material will be handled in accordance with all environmental laws. Material will not be shipped to overseas markets for recycling, material must be processed on the North American continent (USA/Canada/Mexico).

This certifies that the following list states the amount and complete list of end-markets for the materials you sent to [Insert name of service provider].

Material: Amount: End-Market Name/Location: CRTs Plastics Metals Circuit Boards Hazardous Materials Solid Waste Materials

[Insert Name of Vendor] further certifies that we have audited (at least once a year) or have written documentation on the processes and procedures used by our end-markets and that they comply with applicable laws and requirements, and environmentally sound management practices.

[Insert Name of Vendor] further certifies that we have and can provide evidence, upon request, of an environmental safety policy and that we meet Oregon OSHA requirements.

[Insert Name of Vendor] further certifies that we have general liability insurance and/or pollution liability insurance equal to or greater than $1,000,000/occurrence, $1,000,000 aggregate.

Signature____________________________ Date: _____________________

Name and title: ___________________________________________________