OPERS Independent Contractor Form_fillable PDF Form (12).pdf
PDF 249 KB Posted
- Attached to
- Landscaping improvement project for the Magee Marsh Visitor Center State and local contract opportunity
- Solicitation number
- SRC0000032485
- Issued by
- Putnam County, Ohio
About this file
This document is an OPERS (Ohio Public Employees Retirement System) Independent Contractor/Worker Acknowledgment form designed for individuals providing personal services to a public employer on or after January 7, 2013, who are not considered public employees. The form requires independent contractors to complete and submit documentation within 30 days of beginning service, affirming their classification and understanding that no retirement system contributions will be made on their behalf.
The form outlines specific criteria for independent contractor status, including being party to a bilateral agreement, being paid a fee or contractual arrangement, not being eligible for employee benefits, not appearing on a public employer's payroll, providing own supplies and equipment, and receiving an Internal Revenue Service Form 1099 for tax reporting. The document emphasizes that independent contractors are not public employees and may be subject to specific limitations, such as ineligibility for medical reimbursements or retirement allowances during and after the service period. Contractors must acknowledge potential financial liabilities and the right of OPERS to request a determination of their employment classification.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| Affirmation and Disclosure Form_3-4-22 (2).pdf | ||
| 2025 MMVC DESIGN PLANS.pdf | ||
| Addendum to Bid Quote Template (Non-Federal Funds)_for OhioBuys (3).docx | DOCX document | |
| Standard Terms and Conditions (12).pdf | ||
| 2025 MAGEE MARSH PLANT AND SEED LIST.pdf | ||
| Scope of Services_Magee Marsh Visitor Center Gravel Walk and Pollinator Gardens.pdf |
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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 .