ATTACHMENT B - INDEPENDENT CONTRACTOR CERTIFICATION~1.pdf
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- Attached to
- Policy Development Services
- Solicitation number
- S-X03101-00011566
- Issued by
- Clackamas County, Oregon
About this file
This document is an Independent Contractor Certification form to be submitted as part of a state or local government contract opportunity. The form requires the proposer to certify that they meet the criteria to be considered an independent contractor under Oregon state law. Key details include the proposer providing their employer identification number, acknowledging they are a corporation authorized to do business in Oregon, and affirming through their signature that they meet the various requirements to be classified as an independent contractor, such as filing separate business tax returns, providing their own tools and equipment, and meeting at least 4 of the 6 additional criteria outlined in the form. The document does not provide any details about the specific contract opportunity itself, such as the scope of work, quantities, response deadlines, or contract term.
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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: _____________________
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