Small Business Application Form for Personal Protective Equipment (PPE)

   Application Form

Tulsa Regional Chamber, Tulsa County, and the Tulsa Area Emergency Management Agency will begin distributing PPE kits to small businesses the week of June 22 at Expo Square. To receive the PPE you must:

  • Complete all of the information requested on this form
  • Be within Tulsa County and have under 50 employees

All applicants will be verified through the Oklahoma Secretary of State and the Tulsa County Assessor.

No applications will be accepted through email or by phone.

 By clicking this box you agree you are a legal corporation within Tulsa County in the State of Oklahoma and are verified through the Secretary of State and Tulsa County Assessor.  
You will receive an email from the Tulsa Chamber when your request is approved. This email will include information on your pickup date.

RELEASE OF LIABILITY AND ASSUMPTION OF RISK

The company named below (referred to as "I" or "me") has received Personal Protective Equipment ("PPE") from the Tulsa Area Emergency Management Agency ("TAEMA"). As lawful consideration for the PPE that I have received, I agree to all the terms and conditions set forth in this agreement (this "Agreement").

I hereby expressly WAIVE AND RELEASE any and all claims, now known or hereafter known, against TAEMA, TULSA COUNTY, and the TULSA REGIONAL CHAMBER OF COMMERCE and their officers, directors, employees, agents, affiliates, and successors, and assigns, (collectively, the "Releasees"), arising out of or attributable to the PPE received, whether arising out of the negligence of TAEMA or any Releasees or otherwise. I covenant not to make or bring any such claim against TAEMA or any other Releasee, and forever release and discharge TAEMA and all other Releasees from liability under such claims.

This Agreement constitutes the sole and entire agreement of TAEMA and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Releasees and me and their respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of Oklahoma without giving effect to any choice or conflict of law provision or rule (whether of the State of Oklahoma or any other jurisdiction). Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in Tulsa, Oklahoma and I hereby consent to the exclusive jurisdiction of such courts.

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE TAEMA OR ANY RELEASEE.

Each of the persons signing below hereby represents and warrants that they are signing with full and complete authority to bind the party on whose behalf of whom they are signing, to each and every term of this Agreement.

Typing your name in the Signature field constitutes a signature

Company Name:
Address:
Date:
7/6/2020