Attachment C - Sample Contract NEW.pdf

David Douglas School District Learn – Grow - Thrive

DDSD

Contract ID#

Contractor Contract ID#

DAVID DOUGLAS SCHOOL DISTRICT NO. 40

PERSONAL SERVICES CONTRACT

This Personal Services Contract (this "Contract") is between DAVID DOUGLAS SCHOOL DISTRICT NO. 40, a public school district of the State of Oregon ("DISTRICT"), and INSERT CONTRACTOR NAME, a Sole Proprietor in Oregon ("Contractor").

The parties agree as follows:

Effective Date and Termination Date. The effective date of this contract shall be INSERT START DATE.

Unless earlier terminated as provided below, this agreement expires on INSERT TERMINATION DATE.

Renewal. This contract may be renewed on the following basis: District reserves the right to extend this contract upon mutual agreement between District and Contractor for up to six (6) additional years. Any renewals of this contract must be in writing and signed by both parties.

Contractor's Agreement to Provide Services. Contractor agrees to provide the DISTRICT with the Services described in Exhibit 1 (Statement of the Work).

Payment for Work. The DISTRICT agrees to pay Contractor in accordance with Exhibit 3.

Contract Documents. The Contract Documents consist of the following documents which are listed in descending order of precedence:

1. This Contract;

2. Exhibits to this Contract, including

• Exhibit 1 – District’s Solicitation Document and Attachments;

• Exhibit 2 – Contractor’s Solicitation Response;

• Exhibit 3 - Statement of Work, Compensation, Payment;

• Exhibit 4 - Insurance Requirements;

• Exhibit 5 - Certification Statement for Corporation or Independent Contractor; and

• Exhibit 6 - Workers' Compensation Exemption Certificate.

A conflict in the contract documents shall be resolved in the priority listed above with this Contract taking precedence over all other documents. The contract documents are the entire contract between the parties and shall supersede any prior representation, written or oral.

All information in this contract is subject to public records law. Please contact the District point of contact if you have questions.

STANDARD TERMS AND CONDITIONS

1. Time is of the Essence. Time is of the essence in the performance of this Contract.

2. Subcontracts and Assignment. Contractor shall not subcontract any of the work required by this Contract or assign or transfer any of its interest in this Contract, without the prior written consent of the DISTRICT, which may be withheld without cause. In addition to any other provisions the DISTRICT may require, Contractor shall require of any permitted subcontract under this Contract, that the Subcontractor be bound by all the same terms and conditions of this agreement. Such sub-contracts are solely between the Contractor and the Subcontractor and shall not have any binding effect on the DISTRICT.

ATTACHMENT C

RFP #2.26.25.1

DDSD

Contract ID#

3. Other Contractors. The DISTRICT may undertake or award other contracts for additional or related work, and the Contractor shall fully cooperate with such other contractors and with any DISTRICT employees concerned with such additional or related work, and shall coordinate its performance under this contract with such additional or related work. The Contractor shall not commit or permit any act that will interfere with the performance of work by any other contractor or by DISTRICT employees.

4. Independent Contractor Status. Contractor shall certify status as an independent contractor in accordance with Exhibit 3.

5. No Third Party Beneficiaries. The DISTRICT and Contractor are the only parties to this Contract and are the only parties entitled to enforce its terms. Nothing in this Contract gives or provides any benefit or right, whether directly, indirectly, or otherwise, to third persons unless such third persons are individually identified by name in this Contract and expressly described as intended beneficiaries of this Contract.

6. Successors in Interest. The provisions of this Contract shall be binding upon and inure to the benefit of the parties and their successors and approved assigns, if any.

7. Nonperformance. In the event of nonperformance under this contract, the DISTRICT, after seven (7) days written notice, shall have the right to obtain from other sources such products and/or services as may be required to accomplish the work not performed, and it is agreed that the difference in cost, if any, for said work or goods shall be borne by the Contractor. For purposes of this section, nonperformance shall be defined as failure to appear and perform work and/or deliver goods as specified and scheduled.

8. Early Termination. This Contract may be terminated as follows unless otherwise specified herein:

a. The DISTRICT and Contractor, by mutual written agreement, may terminate this Contract at any time.

b. The DISTRICT in its sole discretion may terminate this Contract for any reason on 30 days written notice to Contractor.

c. Either the DISTRICT or Contractor may terminate this Contract in the event of a breach of the Contract by the other. Prior to such termination, the party seeking termination shall give to the other party written notice of the breach and intent to terminate. If the party committing the breach has not entirely cured the breach within 15 days of the date of the notice, then the party giving the notice may terminate the Contract at any time thereafter by giving a written notice of termination.

d. Notwithstanding section 8(c), the DISTRICT may terminate this Contract immediately by written notice to Contractor upon denial, suspension, revocation or non-renewal of any license, permit, or certificate that Contractor must hold to provide services under this Contract.

9. Payment of Invoices

a. Method of Payment. Contractor shall bill DISTRICT monthly as services are performed.

Payment shall be made as provided in Exhibit 1

b. Payment on Early Termination. Upon termination pursuant to Section 8, payment shall be made as follows:

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(i) If terminated under sections 8(a) or 8(b) for the convenience of the DISTRICT, the DISTRICT shall pay Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract. The DISTRICT shall not be liable for direct, indirect or consequential damages. Termination shall not result in a waiver of any other claim the DISTRICT may have against Contractor.

(ii) If terminated under section 8(c) by the Contractor due to a breach by the DISTRICT, then the DISTRICT shall pay the Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract.

(iii) If terminated under sections 8(c) or 8(d) by the DISTRICT due to a breach by the Contractor, then the DISTRICT shall pay the Contractor for work performed prior to the termination date provided such work was performed in accordance with the Contract less any setoff to which the DISTRICT is entitled.

10. Non-Discrimination Certification (Required by ORS 279A.110). The Contractor hereby certifies that the Contractor has not discriminated and will not discriminate against a Subcontractor in the awarding of a subcontract because the subcontractor is a disadvantaged business enterprise, a minority-owned business, a woman-owned business, a business that a service-disabled veteran owners or an emerging small business.

11. Tax Compliance Warranty (Required by ORS 279B.045). Contractor represents and warrants that Contractor has complied with the applicable tax laws of this state or a political subdivision of this state, including but not limited to ORS 305.620 and ORS chapters 316, 317 and 318. Contractor covenants that contractor will continue to comply with the tax laws of this state or a political subdivision of this state during the term of this contract. Failure by the Contractor to comply with the applicable tax laws of this state or a political subdivision of this state before the execution of this Contract or during the term of this Contract is a default for which the District may terminate this Contract and seek damages and other relief available under the terms of this Contract or under applicable law.

12. Payment of Laborers (Required by ORS 279B.220). The Contractor shall:

a. Make payment promptly, as due, to all persons supplying to such Contractor labor or material for the prosecution of the work provided for this contract;

b. Pay all contributions or amounts due the Industrial Accident Fund by the Contractor or subcontractors, if permitted, incurred in the performance of this contract;

c. Not permit any lien or claim to be filed or prosecuted against the DISTRICT on account of any labor or material furnished; and

d. Pay to the Department of Revenue all sums withheld from employees pursuant to ORS 316.167.

If the Contractor fails, neglects or refuses to make prompt payment of any claim for labor or services furnished to it by any person in connection with this contract as such claim becomes due, the DISTRICT may pay such claim to the person furnishing the labor or services and charge the amount of the payment against funds due or to become due the Contractor by reason of such contract.

The payment of a claim in this manner shall not relieve the Contractor or the Contractor's surety, if any, from obligation with respect to any unpaid claims.

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13. Payment for Medical Care and Workers Compensation (Required by 279B.230)

a. Contractor shall promptly, as due, make payment to any person, co-partnership, association or corporation furnishing medical, surgical and hospital care services or other needed care and attention, incident to sickness or injury, to the employees of the contractor, of all sums that the contractor agrees to pay for the services and all moneys and sums that the contractor collected or deducted from the wages of employees under any law, contract or agreement for the purpose of providing or paying for the services.

b. All subject employers working under the contract are either employers that will comply with ORS 656.017 or employers that are exempt under ORS 656.126.

14. Hours of Labor, Pay Equity (Required by ORS 279B.020, 279B.235).

a. The Contractor shall pay the Contractor's employees who work under this Contract at least time and a half pay for all overtime the employees work in excess of 40 hours in any one week, except for employees who are excluded under ORS 653.010 to 653.261 or under 29 U.S.C. Section 201 to 209 from receiving overtime.

b. The Contractor shall comply with ORS 652.220 (Prohibition of discriminatory wage rates based on sex; employer not to discriminate against employee who is a complainant).

Compliance is a material element of the Contract. Failure to comply is a breach that entitles the Owner to terminate the contact for cause.

c. The Contractor may not prohibit any of the Contractor's employees from discussing the employee's rate of wage, salary, benefits or other compensation with another employee or another person, and may not retaliate against an employee who does so.

15. Non-Appropriation/Adequate Funding

a. If payment for work under this Contract extends into the DISTRICT's next fiscal year, DISTRICT's obligation to pay for such work is subject to approval of future appropriations to fund this Contract by the District's Board of Directors.

b. Continuation of this Contract, at specified levels, is conditioned on adequate funding under the DISTRICT's budget adopted in June of each year. DISTRICT reserves the right to adjust the level of services in accordance with funding levels adopted.

16. Remedies. In the event of breach of this Contract the parties shall have the following remedies:

a. If terminated under section 8(c) by the DISTRICT due to a breach by the Contractor, the DISTRICT may complete the work either itself, by agreement with another Contractor, or by a combination thereof. If the cost of completing the work exceeds the remaining unpaid balance of the total compensation provided under this Contract, then the Contractor shall pay to the DISTRICT the amount of the reasonable excess.

b. In addition to the remedies in sections 8 and 9 for a breach by the Contractor, the DISTRICT also shall be entitled to any other equitable and legal remedies that are available.

c. If the DISTRICT breaches this Contract, Contractor's remedy shall be limited to termination of the Contract and receipt of Contract payments to which Contractor is entitled.

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17. Hazardous Materials. Contractors shall notify District prior to using products containing hazardous chemical(s) to which District employees may be exposed. Products containing hazardous chemicals are those products defined by Oregon Revised Statutes, Chapter 465. Contractor shall supply Material Safety Data Sheets (MSDS) OAR Chapter 437, Division 2, subdivision Z.

18. Errors. The Contractor shall perform such additional work as may be necessary to correct errors in the work required under this contract without undue delays and without additional cost.

19. Access to Records. The Contractor agrees that the DISTRICT and its authorized representatives shall have access to the books, documents, papers and records of the Contractor which are directly pertinent to this Contract for the purpose of making audit, examination, excerpts and transcripts.

Contractor shall maintain all fiscal records directly relating to this Contract in accordance with generally accepted accounting principles. In addition, Contractor shall maintain any other records pertinent to this Contract in such a manner as to clearly document Contractor's performance.

Contractor acknowledges and agrees that the DISTRICT's duly authorized representatives shall have access to such fiscal records and other books, documents, papers, plans and writings of Contractor that are pertinent to this Contract to perform examinations and audits and make excerpts and transcripts. Contractor shall retain and keep accessible all such fiscal records, books, documents, papers, plans, and writings for a minimum of three (3) years, or such longer period as may be required by applicable law, following final payment and termination of this Contract, or until the conclusion of any audit, controversy or litigation arising out of or related to this Contract, whichever date is later.

20. Ownership of Work. All work products created by the Contractor as part of Contractor's performance of this Contract, including background data, documentation and staff work that is preliminary to final reports, shall be the exclusive property of the DISTRICT. If any such work products contain intellectual property of the Contractor that is or could be protected by federal copyright, patent, or trademark laws, Contractor hereby grants the DISTRICT a perpetual, royalty-free, fully paid-up, non-exclusive and irrevocable license to copy, reproduce, deliver, publish, perform, dispose of, use, re-use, in whole or in part, and to authorize others to do so, all such work products. The DISTRICT shall have no rights in any pre-existing work product of Contractor provided to the DISTRICT by Contractor in the performance of this Contract except to copy, use and re-use any such work product for DISTRICT use only.

If this Contract is terminated by either party or by default, the DISTRICT, in addition to any other rights provided by this Contract, may require the Contractor to transfer and deliver such partially completed work products, reports or other documentation that the Contractor has specifically developed or specifically acquired for the performance of this contract.

21. Employment Standards. The Contractor agrees that upon request by the District, it shall remove from all District premises any Contractor's employee who, in the sole opinion of the District, is guilty of improper conduct, bringing any unauthorized personnel (including their own children) into a facility, or is not qualified to perform the work assigned.

22. Security. Any disclosure or removal of any matter and/or property on the part of the Contractor or Contractor's employees shall be cause for immediate cancellation of the Contract. Any liability, including, but not limited to, attorney fees, resulting from any action or suit brought against the DISTRICT as a result of the Contractor's or Contractor's employees' willful or negligent release of information, documents or property contained in or on DISTRICT property shall be borne by the Contractor. All information, documents and property contained within these facilities shall be considered privileged and confidential.

23. Compliance with Applicable Law. Contractor shall comply with all federal, state, and local laws applicable to public contracts and to the work done under this Contract, and all regulations and administrative rules established pursuant to those laws.

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24. Public Employee Retirement System. Contractor represents and warrants that (a) Contractor is not active as an employee in the Public Employee Retirement System and (b) Contractor has not received wages from the DISTRICT or any other public entity during this calendar or fiscal year.

25. Indemnity and Hold Harmless. Subject to the conditions and limitations of the Oregon Constitution and Oregon Tort Claims Act (ORS 30.260 to 30.300). Contractor shall defend, indemnify, and hold the DISTRICT, its officers, agents and employees, harmless against all liability, loss, costs, or expenses, including attorney's fees, and against all claims, actions or judgments based upon or arising out of damage or injury (including death) to persons or property caused by any negligent act or omission of an act sustained in any way in connection with the performance of this contract or by conditions created thereby, or based upon violation of any statute, ordinance or regulation. This contractual indemnity provision does not abrogate common law or statutory liability and indemnification to the DISTRICT, but is in addition to such common law or statutory provisions.

26. Insurance. Contractor shall provide insurance in accordance with Exhibit 2.

27. Waiver. Waiver of any default under this Contract by the DISTRICT shall not be deemed to be a waiver of any subsequent default or a modification of the provisions of this Contract.

28. Governing Law. The provisions of this Contract shall be construed in accordance with the laws of the State of Oregon and, rules of the DISTRICT, as they appear at the time of signing or any subsequent addenda. Any legal action involving any question arising under this Contract must be brought in Multnomah County Circuit Court. If the claim must be brought in a federal forum, then it shall be brought and conducted in the United States District Court for the State of Oregon.

CONTRACTOR AGREES TO THE JURISDICTION OF THESE COURTS.

29. Severability. If any term or provision of this Contract is declared by a court of competent jurisdiction to be illegal or in conflict with any law, the validity of the remaining terms and provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Contract did not contain the particular term or provision held invalid.

30. Merger Clause. This Contract and the attached exhibits constitute the entire agreement between the parties. All understandings and agreements between the parties and representations by either party concerning this Contract are contained in this Contract. No waiver, consent, modification or change in the terms of this Contract shall bind either party unless in writing signed by both parties. Any written waiver, consent, modification or change shall be effective only in the specific instance and for the specific purpose given.

31. Anti-discrimination Clause. Contractor must comply with all applicable requirements of federal and state civil rights law and rehabilitation statutes and shall not discriminate based on race, religion, color, sex, marital status, familial status, national origin, age, mental or physical disability, sexual orientation, source of income, or political affiliation in programs, activities, services, benefits or employment. Contractor shall not discriminate against minority-owned, women-owned or emerging small businesses.

32. Rule of Construction. The rule of construction that a contract is construed against the drafter shall not apply to any dispute over the interpretation of application of the contract.

33. When Work is Performed on District Property, Contractor shall comply with the following:

a. Identification. Contractors performing work on District property or for the District shall be in full uniform at all times. Uniforms shall include shirt with company identification attached. In addition, all such persons shall carry photo identification and will present such to anyone on request. If such identification cannot be produced by Contractor, or is not acceptable to the District, the District may provide at its sole discretion, such identification tags to Contractor.

Contractor shall bear the entire cost of producing and assigning such identification.

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Contractors that do not have specific uniforms for employees shall provide identification tags as described above, and/or any other mechanism, that the District in its sole discretion determines is required to easily identify Contractors.

As required by schools served by the District, on each day of work Contractor's employees shall sign into the Main Office to receive an in-school identification/visitor tag to be displayed on the person at all times they are in the school or other location.

b. No Smoking. Smoking or other use of tobacco is prohibited on District property.

c. No Drugs. District property sites and schools served by the District are drug-free zones.

d. No Weapons or Firearms. Except as provided by Oregon statutes and District policy, weapons and firearms are prohibited on District property.

e. Safety. Prior to instituting work on District property, Contractor, its subcontractors, and suppliers shall review the safety and security policies issued by the District's Risk Management Department and shall comply with those policies while on District property.

f. Confidentiality. Contractor will not disclose any information or records regarding students or their families that Contractor may learn or obtain in the course and scope of Contractor's performance of this Contract.

No Unsupervised Contact with Students. "Unsupervised contact with students" means contact with students that provide the person opportunity and probability for personal communication or touch when not under direct supervision of a District employee. Contractor will ensure that Contractor, any subcontractors, and their officers, agents, and employees who will have any direct unsupervised contact with students while on District property have passed a third party background screening. Contractor will enlist the services of a third party background screening provider to perform FBI fingerprint, Social Security Number verification, and investigate criminal arrests and conviction records in all counties reported by the Contractor’s employee(s) for the five year period immediately prior to the date Contractor’s employee is hired by the Contractor. In addition Contractor authorizes the District to obtain information about Contractor and Contractor's history and to conduct a criminal background check, including fingerprinting, of any officer, agent, or employee of Contractor that will have unsupervised contact with students. Contractor will provide results of the screenings to District no later than 4 weeks from the start date of the Contractor’s employee. Contractor also agrees to cause Contractor's employees and/or subcontractors, if any, to authorize the District to conduct such background checks. Contractor shall pay all fees assessed by Oregon Department of Education for processing the background check.

The DISTRICT may deduct the cost of such fees from a progress or final payment to the Contractor under this Contract, unless the Contractor elects to pay such fees directly.

34. FERPA Redisclosure. The Parties recognize that the Family Educational Rights and Privacy Act ("FERPA") imposes strict penalties for improper disclosure or redisclosure of confidential student information, including but not limited to denial of access to personally identifiable information from education records for at least five years (20 U.S.C. § 1232g; 34 CFR Part 99). Therefore, consistent with the requirements of FERPA, personally identifiable information obtained by the Parties in the performance of this Contract may not be redisclosed to third parties without written consent of the students' parent/guardian, and must be used only for the purposes identified in this Contract, except as may be required or authorized by law.

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35. Notices. All notices or demands of any kind required or desired to be given by DDSD or Contractor must be in writing and shall be deemed delivered upon depositing the notice or demand in the United States mail, certified or registered, postage prepaid, addressed to the respective party at the address listed below.

David Douglas School District Attn: Patt Komar 11300 NE Halsey St.

Portland, OR 97220

(503) 261-8212 patt_komar@ddsd40.org

Insert Contractor Name Attn:

ATTACHMENT C

mailto:patt_komar@ddsd40.org

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CONTRACTOR DATA AND SIGNATURE

Business Name:

Business Address:

Contractor Phone:

Federal Tax ID# or Social Security #

Is Contractor a nonresident alien? Yes No

Business Designation (check one): Sole Proprietorship Partnership

Corporation-for profit Corporation-non-profit

Limited Liability Company

Federal tax ID numbers or Social Security numbers are required pursuant to ORS 305.385 and will be used for the administration of state, federal and local laws. Payment information will be reported to the Internal Revenue Service under the name and Federal tax ID number or, if none, the Social Security number provided above.

I have read this Contract including the attached Exhibits. I certify that I have the authority to sign and enter into this Contract. I understand the Contract and agree to be bound by its terms.

Signature Title

Name (please print) Date

NOTE: Contractor must also sign Exhibit 3 and (if attached) Exhibit 4.

DAVID DOUGLAS SCHOOL DISTRICT NO. 40 SIGNATURE

(This contract is not binding on the DISTRICT until signed the appropriate signing authority)

Director of Administrative Services Signature Title

Patt Komar Name (please print) Date

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EXHIBIT 3

Personal Services Contract

STATEMENT OF WORK, COMPENSATION, and PAYMENT

1. Contractor shall perform the following work:

2. The maximum total payment under this Contract, including expenses:

Maximum amount to be paid under this contract, including expenses not listed, is $.

3. The DISTRICT shall pay Contractor on the following basis:

The Contractor shall be paid on a monthly basis following receipt of final invoice. District shall pay invoices net 30 days.

INSUFFICIENTLY DETAILED INVOICES WILL BE REJECTED. INVOICES MUST INCLUDE:

• Invoice date • Payment Rate

• Invoice number • Total payment due

• Contract number • Vendor name

• Invoice period • Remit to address

• Dates of service • Contact information

• Detailed description of service

Invoices may be e-mailed to accounts_payable@ddouglas.k12.or.us or sent to the Business Office at 11300 NE Halsey St., Portland, OR 97220. All invoices must be received within 30 days of the date of service. Questions can be referred to the Business Office at 503-261-8212.

**The DISTRICT shall have the right to withhold from payments due Contractor such sums as are necessary in the DISTRICT's sole opinion to protect the DISTRICT from any loss, damage, or claim which may result from Contractor's failure to perform in accordance with the terms of the Contract or failure to make proper payment to suppliers or subcontractors.

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Contractor shall at all times maintain in force at Contractor's expense, each insurance noted below:

Workers Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage in accordance with ORS Chapter 656 for all subject workers.

Contractor and all subcontractors of Contractor with one or more employees must have this insurance unless exempt under ORS 656.027.

THIS COVERAGE IS REQUIRED. Attach Certificate of Insurance.

Professional Liability/E&O insurance with a combined single limit of not less than ☐ $500,000, ☐ $1,000,000, ☐ $2,000,000 each claim, incident, or occurrence, with an annual aggregate limit of ☐ $500,000, ☐ $1,000,000, ☐ $2,000,000. This is to cover damages caused by error, omission, or negligent acts related to professional services provided under this Contract. This coverage must be provided and remain in force for two years after the completion of the contract.

☐ Required by DISTRICT ☒ Not required by DISTRICT

Commercial General Liability insurance, on an occurrence basis, with a limit of not less than ☐ $500,000, ☐ $1,000,000, ☒ $2,000,000 each occurrence for Bodily Injury and Property Damage, with an annual aggregate limit of ☐ $500,000, ☐ $1,000,000, ☒ $3,000,000. This insurance must include contractual liability coverage. Additionally, insurance must include coverage for allegations of abuse. Abuse coverage may be sublimited to $1,000,000.

☒ Required by DISTRICT ☐ Not required by DISTRICT

Commercial Automobile Liability insurance with a combined single limit, or the equivalent of not less than ☐ $500,000, ☒$1,000,000, ☐ $2,000,000 each occurrence for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles.

☒ Required by DISTRICT ☐ Not required by DISTRICT

Additional Requirements. Coverage must be provided by an insurance company admitted to do business in Oregon or rated A- or better by Best's Insurance Rating. Contractor shall pay all deductibles and retentions. A cross-liability clause or separation of insureds condition must be included in all commercial general liability policies required by this Contract. Contractor's coverage will be primary in the event of loss.

Certificate(s) of Insurance Required. Contractor shall furnish a current Certificate(s) of Insurance to the DISTRICT prior to contract execution. The Certificate(s) shall provide that there shall be no cancellation, termination, material change, or reduction of limits of the insurance coverage without 30 days written notice from the Contractor's insurer to the DISTRICT. The Certificate(s) shall also state the deductible or retention level. For commercial general liability the Certificate shall also provide that the DISTRICT, its agents, officers, and employees are Additional Insureds with respect to Contractor's services to be provided under this Contract. An additional insured endorsement shall be attached to the certificate of insurance. No work shall commence until the District receives the certificate and additional insured endorsement. If requested, complete copies of insurance policies shall be provided to the DISTRICT.

ATTACHMENT C

EXHIBIT 4

Personal Services Contract

INSURANCE REQUIREMENTS

Contract ID#

EXHIBIT 5

Personal Services Contract

CERTIFICATION STATEMENT FOR CORPORATION OR INDEPENDENT CONTRACTOR

NOTE: Contractor Must Complete A or B below:

A. IF CONTRACTOR IS A CORPORATION, LIMITED LIABILITY COMPANY OR A PARTNERSHIP,

THEN ONLY COMPLETE SECTION A

I certify under penalty of perjury that Contractor is a [check one]: Corporation Limited Liability Company Partnership authorized to do business in the State of Oregon.

Signature Title Date

B. OTHERWISE, IF CONTRACTOR IS A SOLE PROPRIETOR WORKING AS AN INDEPENDENT

CONTRACTOR, ONLY COMPLETE SECTION B

Contractor certifies under penalty of perjury that the following statements are true:

1. If Contractor is providing labor or services under this Contract for which registration is required under ORS Chapter 701, Contractor has registered as required by law, and

2. If Contractor performed labor or services as an independent Contractor last year, Contractor filed federal and state income tax returns last year in the name of the business (or filed a Schedule C in the name of the business as part of a personal income tax return), and

3. Contractor represents to the public that the labor or services Contractor provides are provided by an independently established business, and

4. All of the statements checked below are true.

NOTE: Check all that apply. You must check at least four (4) to establish that you are an Independent Contractor.

A. The labor or services I perform is primarily carried out at a location that is separate from my residence or is primarily carried out in a specific portion of my residence which is set aside as the location of the business.

B. I purchase commercial advertising or I have business cards for my business, or I am a member of a trade association.

C. My business telephone listing is separate from my personal residence telephone listing.

D. I perform labor or services only under written contracts.

E. Each year I perform labor or services for at least two different persons or entities.

F. I assume financial responsibility for defective workmanship or for service not provided by purchasing performance bonds, errors and omission insurance or liability insurance, or providing warranties relating to the labor or services I provide.

Contractor Signature Date

Contract ID#

EXHIBIT 6

Personal Services Contract

Workers' Compensation Exemption Certificate

(To be used only when Contractor claims to be exempt from Workers' Compensation coverage requirements)

Contractor is exempt from the requirement to obtain workers' compensation insurance under ORS Chapter 656 for the following reason (check the appropriate classification):

___ SOLE PROPRIETOR

Contractor is a sole proprietor, and Contractor has no employees, and Contractor will not hire employees to perform this contract.

___ CORPORATION - FOR PROFIT

Contractor's business is incorporated, and All employees of the corporation are officers and directors and have a substantial ownership interest* in the corporation, and All work will be performed by the officers and directors; Contractor will not hire other employees to perform this contract.

___ CORPORATION - NONPROFIT

Contractor's business is incorporated as a nonprofit corporation, and Contractor has no employees; all work is performed by volunteers, and Contractor will not hire employees to perform this contract.

___ PARTNERSHIP

Contractor is a partnership, and Contractor has no employees, and All work will be performed by the partners; Contractor will not hire employees to perform this contract, and Contractor is not engaged in work performed in direct connection with the construction, alteration, repair, improvement, moving or demolition of an improvement to real property or appurtenances thereto.**

___ LIMITED LIABILITY COMPANY

Contractor is a limited liability company, and Contractor has no employees, and All work will be performed by the members; Contractor will not hire employees to perform this contract, and If Contractor has more than one member, Contractor is not engaged in work performed in direct connection with the construction, alteration, repair, improvement, moving or demolition of an improvement to real property or appurtenances thereto.**

*NOTE: Under OAR 436-50-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the corporation, or if less than 10% is owned, the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders.

**NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing construction work. The requirements for this exemption are complicated.

Contractor Printed Name Contractor Signature

Contractor Title Date