ATTACHMENT B - INDEPENDENT CONTRACTOR CERTIFICATION.pdf
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- Solicitation number
- S-X03101-00011077
- Issued by
- Oregon
About this file
This document is an Independent Contractor Certification that is part of a Request for Proposals (RFP) for the provision of dairy products to be used in the production of meals in Oregon Child Development Coalition's Head Start Centers throughout the State of Oregon. The RFP is seeking a year-round distributor for these dairy products. Proposers must certify that they meet the requirements to be considered an independent contractor, including filing appropriate tax returns, providing their own equipment, and having the authority to hire and fire employees. The RFP has an ID of 66a0e062f11f1244d3034162 and is related to the State of Oregon.
The RFP does not provide details on pricing terms, set asides, incumbents, funding requirements or sources, or other salient commercial information. The focus of the document is on the certification of the proposer's status as an independent contractor in accordance with Oregon state law.
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ATTACHMENT B
INDEPENDENT CONTRACTOR CERTIFICATION
Proposer:
Employer Iden�fica�on Number:
If the Proposer signs Part A, the remainder of this Cer�fica�on Statement does not need to be completed.
Part A. Proposer is a Corpora�on:
The Proposer/Firm is a corpora�on authorized to do business in the State of Oregon.
Proposer Signature:: _______________________________Date: _______________________________
Part B. Proposer is an Independent Contractor:
I, under penal�es of perjury, cer�fy that I am an independent contractor as defined in ORS 670.600 and that the following statements are true and correct:
1. I have filed Federal and State income tax returns in the name of my business or a business Schedule C as part of the personal income tax return, for the previous year, or expect to file federal and state income tax returns, for labor or services performed as an independent contractor in the previous year.
2. I will furnish the tools or equipment necessary for the contracted labor or services.
3. I have the authority to hire and fire employees who perform the labor or services.
4. I represent to the public that the labor or services are to be provided by my independently established business as four (4) or more of the following circumstances exist. (Please check all that apply):
A. The labor or services are primarily carried out at a loca�on that is separate form my residence or is primarily carried out in a specific por�on of my residence, which is set aside as the loca�on of the business.
B. Commercial adver�sing or business cards are purchased for the business, or I have a trade associa�on membership with
C. Telephone lis�ng is used for the business that is separate from the personal residence lis�ng.
D. Labor or services are performed only pursuant to writen contracts.
E. Labor or services are performed for two or more different persons or agencies within a period of one year.
F. I assume financial responsibility for defec�ve workmanship or for service not provided as evidenced by the ownership of performance bonds, warran�es, errors and omissions insurance or liability insurance rela�ng to the labor or services to be provided.
Proposer Signature: _________________________________ Date: _____________________
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