OPERS Independent Contractor Form_fillable PDF Form (10).pdf
PDF 249 KB Posted
- Attached to
- Cooper Hollow Wetland Dredging
- Solicitation number
- SRC0000019522
- Issued by
- Jackson County, Ohio
About this file
The provided document is an "OPERS Independent Contractor/Worker Acknowledgment" form from the Ohio Public Employees Retirement System (OPERS). This form is to be completed by individuals who begin providing personal services to a public employer in Ohio on or after January 7, 2013, but are not considered public employees, such as independent contractors. The form must be completed within 30 days of beginning the service. The document outlines the personal information required, the public employer information, and the service provided, including the start and end dates.
The related state and local contract opportunity is for the "Cooper Hollow Wetland Dredging" project in Jackson County, Ohio. The project involves removing vegetation and soil to a median depth of 18-24 inches below the set grade pins on an approximately 11,155 square yard area. All woody vegetation must be removed and placed along the boundary of the wetland, and the disturbed soil must be excavated and removed from the site. The excavated fill must be hauled to a separate location and dumped on the Cooper Hollow Wildlife Area off Rempel Road.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Addendum to Bid Quote Template (Non-Federal Funds)_for OhioBuys (1).docx | DOCX document | |
| Affirmation and Disclosure Form_3-4-22.pdf | ||
| CH Wetland 1.pdf | ||
| Fill Dump Location.pdf | ||
| Cooper Hollow Wetland A.pdf | ||
| Standard Terms and Conditions (10).pdf | ||
| Cooper Hollow Wetland scope of work.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
OPERS
INDEPENDENT CONTRACTOR/WORKER
ACKNOWLEDGMENT
Ohio Public Employees Retirement System 277 East Town Street, Columbus, Ohio 43215-4642
Employer Services: 1-888-400-0965 www.opers.org
This form is to be completed if you are an individual who begins providing personal services to a public employer on or after
Jan. 7, 2013 but are not considered by the public employer to be a public employee (e.g, you are an independent contractor) and will not have contributions made to OPERS. This form must be completed not later than 30 days after you begin providing personal services to the public employer.
STEP 1: Personal Information
Social Security Number
Date of Birth
Month Day
I First Name
Year
I
Name of Current Employer
Ml Last Name
0 I am an OPERS or other retirement system benefit recipient
STEP 2: Public Employer Information
Name of Public Employer for Which You Are Providing Personal Services
Employer Contact
First Name Ml Last Name
Employer Code Employer Contact Phone Number
Service Provided to Public Employer
Start Date of Service End Date of Service
Month Day Year Month Day Year
I I I j
PEDACKN (Revised 6/2017) Page 1 (continued on back)
File details come from the government source that posted it. Updated .