3-URS Vendor Form (2).pdf
PDF 134 KB Posted
- Attached to
- South Hills Middle - Boiler Replacement
- Solicitation number
- 26KP17
- Issued by
- Salt Lake County, Utah
About this file
This is a Utah Retirement Systems (URS) vendor form required by the Jordan School District for contractors seeking to work on the South Hills Middle School boiler replacement project in Riverton, Utah, with an alternate to replace a boiler at Bluffdale Elementary in Bluffdale, Utah. The form serves as a pre-qualification document to identify any potential conflicts of interest or compliance issues related to URS retiree re-employment restrictions. The Jordan School District is soliciting bids from qualified contractors for these boiler system replacements in accordance with the State of Utah Procurement Code and applicable administrative rules, with the contract awarded to the lowest responsive and responsible bidder meeting all specifications and requirements outlined in the bid documents.
The URS Vendor Form requires contractors to disclose whether they, or any contractor owner, partner, or principal, have retired from Utah Retirement Systems and are receiving monthly benefits. Any URS retirees seeking to work with the Jordan School District as employees or independent contractors must complete and file a Post-Retirement Employment form (Form RTRT-27A) with URS's Retirement Benefits Department prior to beginning work and must contact URS at 801-366-7770 to verify compliance with Title 49, Utah Code Section 49-11-1207(2). Contractors must submit this completed form along with a W-9 to the Jordan School District's Accounting Department. Non-compliance with URS re-employment reporting requirements may result in the retiree being liable for repayment of any overpayments issued by URS.
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Text version
Name
Business Name
Have you (or the contractor, owner, partner, or principal) retired from
Utah Retirement Systems (URS)?
No *Yes
*If you answered yes:
*Provide your birthdate _________________ (required)
*Type of business you provide _______________________________ (required)
Signature Date
Please submit this form along with the W-9 to the Accounting Department.
Retirees receiving a monthly benefit from URS have restrictions when returning to work. Re-employment includes work or service performed as an employee (paid through Payroll) OR on a contract (as a business or independent contractor paid through Accounting) for a participating URS employer if the retiree is listed as the contractor, owner, partner, or principal of the contractor (business).
If it is discovered that a URS retiree failed to report reemployment to URS on its Post-
Retirement Employment form (Form RTRT-27A) in violation of Title 49, the retiree will be liable to repay URS the amount of any overpayment resulting from the violation to report. See Utah code section 49-11-1207(2).
*The retiree is directed to contact URS's Retirement Benefits Department at 801-
366-7770 before beginning work with Jordan District. You will be asked to complete and file a Post-Retirement Employment form (Form RTRT-27A).
URS Post-Retired Verification
Independent Contractors (1099 Employees)
File details come from the government source that posted it. Updated .