ATTACHMENT B - INDEPENDENT CONTRACTOR CERTIFICATION~1.pdf

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Attached to
401(k) Audit
Solicitation number
S-X03101-00013622
Issued by
Clackamas County, Oregon

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This document is an Independent Contractor Certification form for a state contract opportunity in Oregon, specifically Attachment B of a bidding or proposal package. The form provides two primary paths for contractors: Part A for corporate entities and Part B for independent contractors seeking to certify their business status. For independent contractors, the document requires detailed attestation of their business practices, including filing tax returns, providing their own tools and equipment, having hiring/firing authority, and demonstrating at least four characteristics of an independently established business (such as separate business location, commercial advertising, separate telephone listing, working for multiple clients, or carrying professional insurance).

The certification form is designed to ensure that contractors meet Oregon Revised Statute (ORS) 670.600 definitions of an independent contractor, with the proposer affirming under penalty of perjury that their business meets specific operational criteria. By completing this form, contractors validate their independent business status, which has implications for tax reporting, liability, and contractual engagement with state agencies. The form requires the proposer to provide their business name, employer identification number, and signature, with checkboxes to confirm the specific independent contractor qualifications that apply to their business model.

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Other files

File Type Posted
ATTACHMENT A - PROPOSER CERTIFICATION~1.pdf PDF
ATTACHMENT I - CERTIFICATION REGARDING FEDERAL MATTERS~1.pdf PDF
ATTACHMENT J - SUSPENSION AND DEBARMENT CERTIFICATION~1.pdf PDF
2560343 Notice Intent to Award.pdf PDF
ATTACHMENT K - CERTIFICATION REGARDING LOBBYING DISCLOUSRE OF LOBBYING ACTIVITIES~1.pdf PDF
PROPOSAL SUBMISSSION CHECKLIST~3.pdf PDF
ATTACHMENT G - NOT APPLICABLE INTENTIONALLY LEFT BLANK.pdf PDF
ATTACHMENT M - CONTRACTOR INFORMATION SHEET~1.pdf PDF
ATTACHMENT C - AFFIDAVIT OF NON-COLLUSION~1.pdf PDF
ATTACHMENT H - NOT APPLICABLE INTENTIONALLY LEFT BLANK.pdf PDF
ATTACHMENT L - CLEAN AIR AND WATER CERTIFICATION~1.pdf PDF
ATTACHMENT F - PROPOSER REFERENCE FORM~2.pdf PDF
EXHIBIT 1 SAMPLE CONTRACT FOR RFP.pdf PDF
RFP FISCAL-01 4-1K AUDITOR.pdf PDF
ATTACHMENT E - PROPOSER RESPONSIBILTY FORM~2.pdf PDF
ATTACHMENT D - NON-CONFLICT OF INTEREST CERTIFICATION~1.pdf PDF
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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: _____________________

File details come from the government source that posted it. Updated .