VENDOR QUALIFICATION & INTAKE FORM

Chambers Protective Services / Border Security and Investigations

NOTICE: This document is used to qualify independent contractors for security and gate attendant assignments nationwide. Completion of this form does not constitute an offer of employment.

ASSIGNMENT & IDENTITY

Site/Location Applying For:    Location Applying For      
Full Legal Name:    First and Last Name         
Date of Birth:    Date*   (Required for State License Verification)
Primary Phone:       Phone Number*   
Email:    Email*   
Physical Address:          Street, City, State, Zip            
SSN/Tax ID #:   SSN/TAX ID #*   

MILITARY SERVICE (DD214)

Have you ever served in the U.S. Military?    Yes    No *   
Discharge Status:    Honorable    General    Other
DD214 Availability: Can you provide a Member-4 copy if requested?   Yes   No 
  

LICENSING STATUS

Current Status:   
Licensed Security Professional (Guard Card held)    Unlicensed Contractor (Gate Attendant only)

Future Licensing: If unlicensed, if determined to be needed, are you willing to apply for a Guard Card at your own expense?   Yes   No   

IN-DEPTH STATUTORY DISCLOSURE (Criminal History)

We must verify your eligibility for site access under state and federal law. Failure to disclose a conviction that appears on a background check is grounds for immediate disqualification.

Are you currently on parole, probation, or have any pending criminal charges?  
             Yes/No If Yes please explain.*  

Are you aware of any criminal history that legally prohibits you from holding a security license or accessing a high-security job site (e.g., Felonies, Crimes involving Moral Turpitude, or Domestic Violence convictions)?
Please Select No, I am legally eligible. Yes, I may have a disqualifying record. *   

Conviction History: Excluding minor traffic violations, please list all convictions. We evaluate misdemeanors based on the nature of the offense and the time passed since the conviction.   Please list all convictions   

Verification Consent: I authorize the Company to perform a background investigation. I certify that I have disclosed all relevant criminal history.   I Consent * 
     

SAFETY & DRUG-FREE COMPLIANCE

Drug Use: Do you currently use any illegal drugs or substances that would impair your ability to safely perform your duties?   Yes    No*   If Yes please explain 
  

EQUIPMENT & READINESS

Required Gear: Do you possess/will you obtain:
Black Boots
Black Tactical/Utility Pants
Reliable Personal Transportation
Smartphone with Data
Yes    No   

DRUG AND ALCOHOL TESTING CONSENT AND ACKNOWLEDGEMENT

I,   First Name*   Last Name*, the undersigned, [Applicant / Employee / Independent Contractor], hereby acknowledge and agree to the following terms regarding the drug and alcohol testing policy of Chambers Protective Services / Border Security and Investigations (hereinafter referred to as the "Company").

1. Policy Acknowledgement I understand that the Company maintains a drug-free and alcohol-free work environment. I acknowledge that the Company reserves the right to require applicants, current employees, and active independent contractors to submit to drug and/or alcohol testing (including, but not limited to, urinalysis) as a condition of hiring, continued employment, or continued engagement as an independent contractor.

2. Consent to Testing I freely and voluntarily consent to submit to such testing at the Company’s request. I understand that the Company may order such testing at its sole discretion, at any time, and for any reason deemed necessary by the Company.

3. Procedures and Confidentiality I understand that if testing is ordered:
I will be informed of the testing procedures and the specific substances for which I am being tested.
A copy of the test results will be forwarded to the Company and placed in my confidential personnel or contractor file.
The Company will take all reasonable measures to ensure that the results of any such testing remain confidential, disclosing them only to those with a legitimate need to know or as required by law.

4. Positive Results I understand that in the event of a confirmed positive test result, the Company may, at its sole discretion, provide me with an opportunity to explain or rebut the finding prior to taking final disciplinary or administrative action.

5. No Alteration of At-Will Status I understand that this agreement and consent to testing do not alter the "at-will" nature of my employment or contract relationship with the Company.

ACKNOWLEDGED AND AGREED:   First Name   Last Name   Date*   

DRUG AND ALCOHOL TESTING CONSENT AND ACKNOWLEDGEMENT

I,   First Name*   Last Name*, the undersigned, [Applicant / Employee / Independent Contractor], hereby acknowledge and agree to the following terms regarding the drug and alcohol testing policy of Chambers Protective Services / Border Security and Investigations (hereinafter referred to as the "Company").
1. Policy Acknowledgement I understand that the Company maintains a drug-free and alcohol-free work environment. I acknowledge that the Company reserves the right to require applicants, current employees, and active independent contractors to submit to drug and/or alcohol testing (including, but not limited to, urinalysis) as a condition of hiring, continued employment, or continued engagement as an independent contractor.

2. Consent to Testing I freely and voluntarily consent to submit to such testing at the Company’s request. I understand that the Company may order such testing at its sole discretion, at any time, and for any reason deemed necessary by the Company.

3. Procedures and Confidentiality I understand that if testing is ordered:
I will be informed of the testing procedures and the specific substances for which I am being tested.
A copy of the test results will be forwarded to the Company and placed in my confidential personnel or contractor file.
The Company will take all reasonable measures to ensure that the results of any such testing remain confidential, disclosing them only to those with a legitimate need to know or as required by law.

4. Positive Results I understand that in the event of a confirmed positive test result, the Company may, at its sole discretion, provide me with an opportunity to explain or rebut the finding prior to taking final disciplinary or administrative action.

5. No Alteration of At-Will Status I understand that this agreement and consent to testing do not alter the "at-will" nature of my employment or contract relationship with the Company.

ACKNOWLEDGED AND AGREED: 
  First Name*   Last Name*  
 Date*  
 Signature*   

MASTER INDEPENDENT CONTRACTOR AGREEMENT

THIS AGREEMENT (the “Agreement”) is made and effective as of this day   Date   

BETWEEN:

CHAMBERS PROTECTIVE SERVICES / BORDER SECURITY AND INVESTIGATIONS (the “Company”), a business entity located at: 404 MADDOX ST, PO BOX 1346, EDEN, TX 76837

AND:

   First Name*   Last Name*      (the “Contractor”), an individual or business entity located at:   

Street Address*      City*   State*  

    

BACKGROUND The Company manages security and logistics contracts for various property owners ("Clients"). The Contractor is an independent professional engaged in the business of providing security or gate attendant services. The Company desires to subcontract specific Client locations to the Contractor, and the Contractor desires to accept such assignments.

THE PARTIES AGREE AS FOLLOWS:

1. SCOPE OF WORK

1.1 Work Orders: The Company will offer specific assignments to the Contractor via "Work Order" (which may be sent via text, email, or dispatch software). The Contractor is free to accept or decline any assignment.

1.2 Client Instructions: The Contractor acknowledges that all specific duties (e.g., who to let in, when to lock gates) come directly from the Client’s Post Orders or Site Requirements. The Company is merely the administrator of the contract.

The Company does not "supervise" the Contractor’s daily work. The Contractor agrees to follow the Client’s instructions as a condition of getting paid.

1.3 Results-Oriented: The Contractor is retained to achieve a specific result (e.g., a secure perimeter). The Company does not control the manner or methods the Contractor uses to achieve that result.

2. EQUIPMENT AND VEHICLES

2.1 Personal Gear: The Contractor is responsible for providing their own personal trade equipment (boots, flashlight, belt, etc.) unless otherwise agreed.

2.2 Site-Specific Vehicles: The Client or Company may provide a vehicle, golf cart, or truck for use exclusively on the job site.

Not a Personal Benefit: The Contractor acknowledges that this vehicle is "Site Infrastructure" (like a gate or camera) necessary to fulfill the Client’s requirements. It is not a company car for personal use.

Fuel/Charging: Fuel or charging provided is solely for the operation of the vehicle on the Client's property.

Liability: The Contractor is responsible for any damage to the vehicle caused by their own negligence or misuse.

3. INDEPENDENT STATUS

3.1 Business Relationship: The parties agree that this is a business-to-business relationship. The Contractor is notan employee of the Company.

3.2 No Benefits: The Contractor is not entitled to overtime pay, health insurance, paid time off, or retirement benefits.

3.3 Taxes: The Contractor is solely responsible for all federal and state taxes (including Self-Employment Tax). The Company will not withhold taxes from the Contractor's pay.

3.4 Freedom to Work Elsewhere: The Contractor is free to work for other security companies or clients, provided it does not interfere with the safety of the current assignment.

4. PAYMENT TERMS

4.1 Rates: The pay rate will be agreed upon for each specific assignment (Work Order).

4.2 "Pay-When-Paid": The Contractor understands that the Company gets paid by the Client first, and then pays the Contractor. However we will make disbursements available if possible earlier than such.

Agreement: The Company’s obligation to pay the Contractor is contingent upon the Company receiving payment from the Client.

4.3 Invoicing: The Contractor must submit accurate time logs or invoices to get paid.

5. REGULATORY COMPLIANCE

5.1 Licenses: The Contractor promises that they hold a valid state Security License (Guard Card) and any other licenses required by law to perform the work.

5.2 Insurance: If the Contractor uses their own vehicle, they must maintain their own auto insurance.

6. LIABILITY AND INDEMNITY

6.1 Responsibility: The Contractor is responsible for their own actions. If the Contractor causes damage, injury, or loss to the Client or a third party, the Contractor agrees to pay for it (indemnify the Company).

6.2 Misclassification: The Contractor confirms they are an independent contractor. If the Contractor later files for unemployment or workers' compensation claiming to be an employee, the Contractor agrees to reimburse the Company for any resulting fines or legal fees.

7. DISPUTE RESOLUTION

7.1 Arbitration: Any legal dispute between the parties will be settled by binding arbitration in Eden, Texas, not in court.

7.2 CLASS ACTION WAIVER: THE CONTRACTOR WAIVES THE RIGHT TO SUE THE COMPANY AS PART OF A CLASS ACTION LAWSUIT. Any claims must be brought individually.

8. CALIFORNIA SPECIFIC ADDENDUM (Only applies to work in CA)

If the Contractor performs work in California, the Contractor certifies that:

They are free from the Company's control;

They are in business for themselves; and

They understand they are a separate business entity contracting with the Company.

IN WITNESS WHEREOF, the parties have signed this Agreement.

COMPANY: Chambers Protective Services / Border Security and Investigations

Signature: _________________________________

Date: _________________________________

CONTRACTOR:

Signature:   Signature*   

Print Name:   First Name*   Last Name*  

 Date:   Date   

SSN or Tax ID:    SSN/Tax ID*   

INDEPENDENT CONTRACTOR: SITE ASSET RESPONSIBILITY AGREEMENT

THIS AGREEMENT is made between Chambers Protective Services / Border Security and Investigations("Company") and the Independent Contractor named below ("Contractor").

CONTRACTOR NAME:    First Name   Last Name   DATE:   Date   

1. NATURE OF ACCESS (Not "Issued Property") The Contractor acknowledges that for the duration of specific Work Orders, the Company or its Client may grant the Contractor temporary access to certain on-site infrastructure, including but not limited to:

Guard Shacks / Gate Houses

Patrol Vehicles / Golf Carts

On-Site Keys / Access Badges

Stationary Communication Systems (Base Stations)

The Contractor acknowledges that these items are Site Assets necessary for the fulfillment of the Client’s scope of work. They are not personal property issued to the Contractor, nor are they a benefit or perquisite of the engagement.

2. LIMITATION OF USE The Contractor agrees that Site Assets are to be used exclusively for the performance of contracted security services at the designated job site.

Vehicles: Any vehicle provided is for patrol and security purposes on the premises only. It shall not be used for personal errands, commuting, or off-site travel.

Facilities: Guard shacks and gate houses shall be maintained in a clean and professional condition.

3. DAMAGE AND NEGLIGENCE The Contractor agrees to exercise reasonable professional care in the use of all Site Assets.

Liability: The Contractor assumes full financial liability for any damage, destruction, or loss of Site Assets caused by the Contractor’s gross negligence, misuse, or intentional misconduct.

Reporting: The Contractor must immediately report any pre-existing damage to a Site Asset upon starting a shift. Failure to report pre-existing damage may result in the Contractor being held liable for said damage.

4. RETURN AND SURRENDER The Contractor agrees that all access to Site Assets is automatically revoked upon the completion of the specific shift or Work Order. Keys, fobs, and vehicle transponders must be returned to the designated lockbox or Site Supervisor at the end of every shift and may not be removed from the premises.

5. INDEMNIFICATION FOR LOSS In the event that a Site Asset is lost, stolen, or damaged due to the Contractor's negligence (e.g., losing a master key, crashing a patrol vehicle while texting), the Contractor agrees to indemnify the Company for the Full Replacement Cost or repair cost of the item.

AUTHORIZATION TO SET-OFF: The Contractor explicitly authorizes the Company to deduct (set-off) the cost of such repairs or replacements from any outstanding invoices or payments owed to the Contractor, to the fullest extent permitted by law.

I HAVE READ AND UNDERSTAND THIS AGREEMENT.

CONTRACTOR SIGNATURE:    Signature*   

DATE:    Date   

INDEPENDENT CONTRACTOR PAYMENT ENROLLMENT

INSTRUCTIONS: Please complete ALL information below. This form authorizes Chambers Protective Services / Border Security and Investigations ("Company") to remit payments for services rendered.

Contractor / Business Name:    Contractor/Business Name*    
Address:   Street Address, City, State, Zip                  
Tax ID / SSN:    Tax Id/ SSN*   

1. ACCOUNT OWNERSHIP CERTIFICATION

I certify that the bank account and/or digital payment handles listed below are legally registered in my name (or my business entity's name). I understand that the Company will not remit payments to third-party accounts (e.g., a spouse, friend, or relative) to ensure accurate tax reporting and fraud prevention.

2. PAYMENT METHOD SELECTION

Please fill out the sections for your preferred methods of payment.

OPTION A: DIRECT DEPOSIT (ACH)

I authorize the Company to initiate credit entries (deposits) to the account below. I also authorize the Company to initiate debit entries (withdrawals) only if necessary to correct a clerical error or overpayment.

Bank Name:  Bank Name  
 Routing Number (9 Digits):   Routing Number    
Account Number:   Account Number  
 Type of Account:    Checking 1   Savings 2      

OPTION B: DIGITAL PAYMENTS

Complete this section if you prefer to receive service payments via digital platforms.

I authorize the Company to remit payments to the specific user handles listed below. I understand and agree that:
The Company is not responsible for funds sent to an incorrect handle/tag provided by me.
Once the transaction shows as "Sent" or "Completed" on the Company’s end, the Company’s payment obligation is satisfied.
The Company is not liable for service outages, hacking, or account freezes on third-party platforms.

Zelle (Phone/Email):   Zelle Info 
Cash App ($Cashtag):    Cashtag   
Venmo (@Username):    Venmo @ Username   
Apple Pay (Phone #):    Apple Pay Phone #   

TAX REPORTING ACKNOWLEDGEMENT (Form 1099)

By signing below, I expressly acknowledge and agree to the following:
No Tax Withholding: As an Independent Contractor, I understand that no federal, state, or local taxes (including Social Security/Medicare) will be withheld from my payments.

Form 1099-NEC: I understand that if my total compensation from the Company exceeds $600.00 in a calendar year, the Company will report these earnings to the IRS and issue me an IRS Form 1099-NEC (Nonemployee Compensation).

Tax Responsibility: I acknowledge that I am solely responsible for setting aside funds to pay my own self-employment taxes and income taxes.

4. AUTHORIZATION

This authorization is to remain in full force and effect until the Company has received written notification from me of its termination or modification.
Contractor Signature:    Signature*   
Date:    Date*   
     

MUTUAL ARBITRATION AGREEMENT AND CLASS ACTION WAIVER

THIS ARBITRATION AGREEMENT (“Agreement”) is made and entered into by and between Chambers Protective Services Inc. / Border Security and Investigations (“Company”) and the undersigned Independent Contractor (“Contractor”).

1. INTENT AND GOVERNING LAW The parties agree that any legal dispute between them shall be resolved by binding arbitration rather than in court. This Agreement is intended to apply to the broadest extent permitted by law.
Federal Preemption: The parties acknowledge that the Contractor’s services involve interstate commerce. Accordingly, this Agreement is governed by the Federal Arbitration Act (9 U.S.C. §§ 1-16) (“FAA”), which supersedes any state law to the contrary.

2. CLAIMS SUBJECT TO ARBITRATION This Agreement covers any and all claims, disputes, or controversiesthat the Company may have against the Contractor or that the Contractor may have against the Company (including its officers, directors, owners, affiliates, and agents). Claims subject to arbitration include, but are not limited to:
Contract & Payment: Claims for breach of contract, non-payment, unjust enrichment, or promissory estoppel.
Classification & Wages: Any claim that the Contractor was misclassified as an independent contractor, or claims for unpaid wages, overtime, minimum wage, meal/rest breaks, or expense reimbursements.
Torts & Discrimination: Claims for fraud, defamation, negligence, emotional distress, discrimination, harassment, or retaliation.
Statutory Claims: Any claim arising under the Civil Rights Act, ADA, ADEA, FLSA, or any other federal, state, or local statute.

3. CLAIMS EXCLUDED The only claims excluded from mandatory arbitration are:
Claims for workers’ compensation or state unemployment insurance benefits (where applicable).
Claims for injunctive relief regarding the theft of trade secrets, confidential information, or non-solicitation violations.
Claims that, as a matter of strict federal law, cannot be subject to mandatory arbitration (e.g., claims under the Ending Forced Arbitration of Sexual Assault and Sexual Harassment Act).

4. CLASS ACTION WAIVER (CRITICAL) THE CONTRACTOR AND COMPANY AGREE TO BRING ANY DISPUTE IN ARBITRATION ON AN INDIVIDUAL BASIS ONLY, AND NOT ON A CLASS, COLLECTIVE, OR REPRESENTATIVE BASIS.
No Consolidation: There shall be no right or authority for any dispute to be brought, heard, or arbitrated as a class action, collective action, or private attorney general action on behalf of a class of persons or the general public.
Enforceability: The arbitrator shall not have the authority to hear a class or collective action. Disputes regarding the validity or enforceability of this Class Action Waiver shall be decided only by a court of competent jurisdiction, not by the arbitrator.

5. CALIFORNIA SPECIFIC PROVISIONS (PAGA & VENUE) To the extent the Contractor performs services in California, the following provisions apply:

A. PAGA Waiver: The Contractor and Company agree to arbitrate any "individual" claim under the Private Attorneys General Act (PAGA). The Contractor waives the right to bring any "representative" PAGA claim on behalf of others to the fullest extent permitted by law. If a court determines this representative waiver is unenforceable, the parties agree that the individual PAGA claim shall be arbitrated first, and any remaining representative claims shall be stayed (paused) in court pending the outcome of the individual arbitration.
B. Venue & Choice of Law: Notwithstanding any other provision, if the Contractor primarily resides and works in California, the arbitration shall take place in the county where the services were performed, and the substantive laws of California shall apply to the dispute (excluding California laws that favor avoiding arbitration). This clause ensures compliance with California Labor Code § 925.

6. ARBITRATION PROCEDURES
Administrator: The arbitration shall be administered by the American Arbitration Association (AAA) in accordance with its Commercial Arbitration Rules (or Employment Arbitration Rules if required by law to ensure enforceability).
Delegation Clause: The arbitrator, and not any federal, state, or local court or agency, shall have exclusive authority to resolve any dispute relating to the interpretation, applicability, enforceability, or formation of this Agreement, including any claim that all or any part of this Agreement is void or voidable.
Location (Non-California): For services performed outside of California, the arbitration shall take place in Eden, Texas, unless the Contractor can demonstrate that this venue creates an "unconscionable hardship," in which case the venue shall be the federal judicial district where the services were performed.
Arbitration Costs: The Company shall pay the arbitrator’s fees and administrative costs unique to arbitration. The Contractor shall be responsible for a filing fee equal to the applicable filing fee for a lawsuit in state court. Each party shall pay its own attorney’s fees, unless the arbitrator awards fees to the prevailing party under applicable law.

7. SEVERABILITY If any provision of this Agreement is found to be unenforceable, that provision shall be severed, and the remainder of this Agreement shall remain in full force and effect. However, if the Class Action Waiver (Section 4) is found to be unenforceable, then the entire Agreement shall be null and void, and the dispute shall proceed in court.

8. VOLUNTARY ACKNOWLEDGEMENT BY SIGNING BELOW, THE CONTRACTOR ACKNOWLEDGES THAT THEY HAVE READ AND UNDERSTAND THIS AGREEMENT. THE CONTRACTOR UNDERSTANDS THAT THEY ARE GIVING UP THE RIGHT TO A TRIAL BY JURY AND THE RIGHT TO PARTICIPATE IN A CLASS ACTION LAWSUIT.
AGREED AND ACCEPTED:

COMPANY: Chambers Protective Services Inc. / BSI
Authorized Signature:   
Name: Amber Arriaga 
Title: Company Representative
 Date:   Date   

CONTRACTOR:
Signature:   Signature*   
 Printed Name:    First Name*   Last Name*   
Date:   Date*