AUTHORIZATION TO RELEASE INFORMATION
The undersigned (“Customer”), a customer of Performance Food Group, Inc. and/or its subsidiaries (“Performance”), hereby requests Performance to disclose information regarding Customer’s members’ purchasing information (the “Information”) to the following entity (the “Third Party Recipient”):
Third Party Recipient: National Purchasing Partners
Customer hereby acknowledges that the Information disclosed to the Third-Party Recipient may contain confidential and proprietary information of Customer and/or one or more of its members. Customer hereby waives and releases Performance and its subsidiaries from any and all claims, demands, actions, causes of action, liability, damages and demands of any kind whatsoever (“Claims”) that Customer may have against Performance in connection with Performance’s disclosure of the Information to the Third-Party Recipient. Further, Customer shall defend and indemnify Performance and its subsidiaries from and against any and all Claims and any related liabilities, losses, penalties, judgments, fees (including but not limited to reasonable attorneys’ fees), costs and expenses that may be incurred by or assessed against Performance in connection with Performance’s disclosure of the Information to the Third-Party Recipient.
To the extent Customer receives any remuneration from Third Party Recipient or any other third party in exchange for the disclosure of such information or the members’ purchases of any products, Customer warrants and represents that such remuneration does not violate any applicable federal, state, or local law, including but not limited to the federal Anti-Kickback Statute (42 U.S.C. § 1230a-7b(b)).
This authorization shall continue in effect until Performance receives written notice of its revocation from Customer. All such notices shall be provided to Performance at Performance Food Group, Inc., 12500 West Creek Parkway, Richmond, VA 23238, Attn: VP, National Accounts with a copy to Performance Food Group, Inc., 12500 West Creek Parkway, Richmond, VA 23238, Attention: General Counsel.
Name of Customer Account:
Customer Account Number:
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