APPROVED WC WAIVER- Robert Helmer.pdf

210 KB Posted

Attached to
Master Agreement AZ|CTR054971
Contract number
CTR054971
Issued by
Arizona

About this file

Written by GovTribe AI ·

This document is a Workers' Compensation Waiver for a Sole Proprietor/Independent Contractor between the Arizona Department of Transportation (ADOT) and Robert Helmer, a sole proprietor based in Phoenix, Arizona. The waiver is specific to ADOT's Risk Management and Procurement divisions, with a contract identification number of CTR054971, dated March 20, 2023. The document establishes the legal framework for an independent contractor relationship under Arizona Revised Statutes (A.R.S. §§ 23-901, 23-902, and 23-961).

The waiver outlines the terms of engagement, specifically stating that Helmer is an independent contractor performing a defined job for ADOT without being subject to direct supervision or control. Key provisions include that ADOT will not provide tools, dictate performance time, or pay a salary, but instead will compensate based on a fixed contract amount. The document emphasizes that Helmer is not entitled to workers' compensation benefits from ADOT and, if he has employees, he must maintain his own workers' compensation insurance. The contract maintains separation between ADOT's business operations and Helmer's service delivery, with termination possible only under specific conditions such as contract breach or funding unavailability.

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Other files

File Type Posted
CTR05471_Contract_Amendment_Summary_1.pdf PDF
CTR054971_Contract_Amendment_3.pdf PDF
CTR054971_Contractor_Proposal.pdf PDF
APPROVED ANY_ALL GL,AL, 01.17.23-01.17.24.pdf PDF
CTR054971_Contract_Amendment_Summary_2.pdf PDF
Contract_Administration_Documents.pdf PDF
APPROVED CTR054971, CTR063646 PROFESSIONAL 01.24.23-01.24.24.pdf PDF
APPROVED GL,AL 01.17.22-01.17.23.pdf PDF
CTR054971_Contract_Amendment_4.pdf PDF
CTR054971_Contract_Documents.pdf PDF
CTR054971_SPO_Form_205_Forced_Labor_of_Ethnic_Uyghurs_Ban.pdf PDF
APPROVED 01.17.2021 - 01.17.2022.pdf PDF
APPROVED PROFESSIONAL 01.24.22-01.24.23.pdf PDF
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Robert Helmer

4409 E Friess Drive

Phoenix AZ 85032AZ

3/20/2023

DocuSign Envelope ID: 9C34F45B-434C-47F7-AE7A-EFA02ACD0552

CTR054971

Arizona Department of Transportation - Procurement

ACCEPTED

ADOT Risk Management

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