ATTACHMENT B - INDEPENDENT CONTRACTOR CERTIFICATION.pdf
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- Attached to
- RFP 24-USDA-1 Broadline Groceries and the Storage and Distribution of USDA Food Products and Supplie
- Solicitation number
- S-X03101-00011019
- Issued by
- Hood River County, Oregon
About this file
This document is an Independent Contractor Certification form for a state and local contract opportunity in Oregon. The contract is for retaining a year-round distributor to provide broad-line grocery supplies for meals in Oregon Child Development Coalition's Head Start Centers throughout the state. The contractor must meet the requirements of an independent contractor as defined in ORS 670.600, including filing tax returns, providing their own tools and equipment, and having the authority to hire and fire employees. The contractor must also demonstrate at least four of the six specified circumstances related to their independently established business. The contract opportunity ID is 66a0e095f11f1244d3034176.
The pricing and other commercial terms are not provided in this document. The contract opportunity is funded by the state of Oregon, but the specific funding requirements and sources are not detailed. There is no information provided about any incumbent contractors or the current procurement environment.
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Text version
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: _____________________
File details come from the government source that posted it. Updated .