Fill - Free fillable CORE Independent Contractor Packet.1018 (City of Coppell) PDF form

Program Proposal Handbook

and Application

Coppell Parks and Recreation Department

255 Parkway Blvd, Coppell, Texas 75019

www.coppelltx.gov

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Welcome

Thank you for your interest in programming for the City of Coppell Parks and Recreation

Department. The City values its partnerships in providing the highest quality services to

the community and achieving positive outcomes.

Program instructors play an important role in providing services for our patrons.

Program instructors are expected to adhere to the City’s Mission, Vision, and Values

which you will find in this booklet’s introduction. Program instructors are also

expected to follow all City policies and procedures, many of which are discussed

throughout the booklet. The City has a customer experience mentality and we put

our patrons first in everything we do. Our patrons are the reason why we exist.

The Coppell Parks and Recreation Department provides a wealth of classes and

programs for the public to enjoy. Together we have a fantastic opportunity to

make a positive impact on the community in which we live, work, and play. Some

of the benefits of Recreation include, building self-esteem and positive self-image,

developing life skills essential for child development, reducing isolation and

loneliness, building strong families, building social skills, reducing stress, and

enhancing overall health and well-being. The Parks and Recreation Department is

committed to serving as the community’s health and wellness partner.

Contracting Staff

Sheri

Belmont

Manager

Recreation Center

sbelmont@coppelltx.gov

972-462-5107

Recreation

Programs

VACANT

Recreation

Coordinator

Fitness & Adult

Athletics

Jonathan

Winters

Recreation

Supervisor

jwinters@coppelltx.gov

972-304-7038

Senior Programs

Laci

McKinney

Manager

Senior Center

lmckinney@coppelltx.gov

972-462-5138

Environmental

Programs

Molly

Bujanda

Manager

Community Programs

mbujanda@coppelltx.gov

972-462-5165

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Introduction

The information contained in this booklet is intended for current instructors and those who are

interested in becoming instructors. The booklet is a resource of information related to instructing

a “fee” program for the Coppell Parks and Recreation Department. As an instructor with the

City, you are considered an independent contractor with distinct professional skills and expertise

in the area in which you are providing instruction. It is also understood that the City does not

perform the services that you offer as part of its regular business.

As an independent contractor, you are in charge of organizing your curriculum, course

instruction, and all materials as you deem appropriate for the class. Although the City will

provide a facility, park or site to teach your course, we will coordinate enrollment of participants

and provide some advertising through our activity guide. The City will not provide equipment or

supplies for the program, nor dictate or control the manner in which you organize your course

instruction or how you teach your course.

The Parks and Recreation Department operates under the following Mission, Vision and Values

statements and goals, and it is intended that the courses offered to its residents and others,

reflect these values and goals.

MISSION, VISION AND VALUES

COPPELL PARKS AND RECREATION MISSION STATEMENT

We provide Responsible Stewardship of natural and allocated resources through

recreational and educational opportunities that enhance the health, safety, and quality of

life for individuals and the community.

COPPELL PARKS AND RECREATION VISION STATEMENT

A community connected through people, parks, and programs.

ORGANIZATIONAL VALUES

❖ Commitment - We have the courage to sacrifice our own comfort and freedoms in

order to provide for the health, safety, and welfare of both those whom we serve and our

fellow employees, and we do so willingly and without regret.

❖ Equality - Discrimination based on race, gender, age, color, creed, disability or religious

preference will not be tolerated.

❖ Personal Integrity - We recognize that we hold a special position of public trust and

must preserve that trust by always being truthful and honest, while maintain the highest

ethical standards.

❖ Teamwork - We must depend upon one another in order provide excellent and cost

effective services and programs to our community and believe team spirit is fostered

when we voluntarily offer to assist one another.

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❖ Personal Development - We avail ourselves of opportunities offered or suggested by

our organization in order to maintain and improve our skills and abilities as needed to

serve a growing community and a constantly changing environment.

❖ Leadership - We demonstrate leadership by example and practice, looking for

opportunities and volunteering to lead the work and activities of others, promoting

excellence in all these efforts.

❖ Professionalism - Regardless of the job or duty we are asked to perform in the service

of our community, we do so with pride and professionalism.

❖ Respect for Others - In exercising the duties, responsibilities, and authority given to us,

we do so with respect and dignity for the diversity of all living creatures.

Why program for Coppell Parks

and Recreation?

The Coppell Parks and Recreation Department is committed to be the primary recreation

provider of choice for the Coppell Community. As a contract instructor we commit to offer you

the following:

➢ The Parks and Recreation Department uses a technologically advanced computer

registration system that allows us to maintain facility booking for your program and to

process registrations in an efficient manner. Instructors will have access to print and

view attendance reports and class/program rosters.

➢ Participants have two (2) ways of registering for classes: online or in person and we

accept cash, checks, and credit card payments. We take the registration hassle out of

instructor’s duties.

➢ The Coppell Activities Guide is printed 3 times a year and all programs in our system

that meet deadline for publication will be included in the guide.

➢ In addition to the guide, the Parks and Recreation Department sends eBlasts, news

releases, Facebook posts and continually updates our website for accurate information.

➢ Flyers/additional brochures specific to your program can be displayed in the facility. We

will print color copies at no charge for the instructor. All marketing materials must be

approved by Supervisor. Flyers/brochures will be branded with our affiliated logo and

information.

➢ The electronic display monitors throughout the facility are available for additional

marketing opportunities. Specific programs have opportunity to be displayed on other

City facility monitors.

➢ Throughout the year there are opportunities to provide marketing materials at special

events, open houses, and fairs. Instructors are often invited to participate in these type

events to promote their program in person.

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Instructor Requirements

As an Independent Contractor, both parties will be acting in an independent capacity and not as

agents, employees, partners or joint ventures of one another. Contractors are not employees of

the City of Coppell and are not entitled to any rights, benefits, or privileges of employees.

As an Independent Contractor, you oversee organizing your own curriculum, course instruction,

and all materials as you deem appropriate for your class. Classes, programs, and camps may

be designed for preschoolers, school age children, teens, and adults. It may be sports, fitness,

educational, or cultural arts such as; fine arts, performing arts, and crafting. We are always

open to new trending and creative program ideas.

1. Instructor Application – required by all potential Independent Service

Providers/Instructors.

2. Class/Program/Camp Proposal – required for first time program and updated each

season as necessary for program changes.

3. Annual Contract – A new Independent Service Provider Contractor Agreement must be

completed annually. Required forms included in this contract are (but not limited to):

• Independent Service Provider Questionnaire

• Company Information Sheet

• Conflict of Interest Questionnaire

• Electronic Funds Transfer (EFT) Payment Authorization Form

• IRS W-9

4. Insurance Requirements – All Instructors/Contractors are required to obtain and

maintain general liability insurance of a minimum of $1,000,000 per occurrence. A

Certificate of Liability Insurance is required to be on file, with the City of Coppell listed as

a Certificate Holder and as an Additional Insured. An Endorsement Page must

accompany insurance certificate. Certificate Holder and Additional Certificate Holder will

be listed as:

The City of Coppell

255 Parkway Blvd

Coppell, TX 75019

5. Background Check and Drug Screening – Each instructor who will provide services

under this contract must provide a City approved drug and alcohol test and a criminal

history background check a minimum of 2 weeks prior to start of class/program.

6. Contract instructors are required by the City of Coppell to be a licensed business

– The City of Coppell is not authorized to contract with Single-Member LLCs or Sole

Proprietors. Therefore, if you fall into that category, there is a possibility you may be

hired as a city employee to instruct programs/classes.

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Submitting a Proposal

1. Submit an Independent Contractor Application, Independent Service Provider

Questionnaire, Conflict of Interest Questionnaire about yourself and your business.

Complete the New Class/Program Proposal Form and then submit your paperwork to

the appropriate supervisor listed on page 2.

2. After review, we will contact you via email or phone. If further information is needed

and/or your proposal is accepted, you will be asked to set up an in person meeting to

discuss further.

3. Classes for which the department will not accept proposals for are as follows:

a. Programs that are similar to programs we currently offer (please review the most

recent Activity Guide available online at www.coppelltx.gov/parks

(Some proposals may be filed for future consideration)

b. Programs that have been offered in the past but have been cancelled,

unless you can demonstrate you have the necessary number of

participants who are interested.

c. The department does not rent rooms in our facilities for the purpose of

hosting classes or programs that are either similar to what we currently

offer or ones that have a fee associated with them.

4. Submitting a proposal does not guarantee that a class or activity will be

added to the City’s recreation offering or to the Activity Guide. Additionally, once added,

there are no guarantees the department will continue to offer the activity or program.

(There is no exclusivity to instructors or the classes they teach)

5. Proposals are due several months in advance prior to start of any new program. To

ensure your class/program is considered for the appropriate time of year, your

Application and Proposal must be submitted in advance by the following deadlines:

SUMMER (June – August) Deadline January 1

FALL (September – December) Deadline May 1

WINTER/SPRING (January – May) Deadline September 1

6. Holidays and Class Cancellations – The facilities will be closed for the major holidays

and no programs will be scheduled. During the school year, we avoid scheduling regular

on-going programs when children are on school holidays and breaks. The exceptions

will be for the fall, winter, and spring breaks when children are out of school for a longer

period of time. We may schedule camps and specialty classes for those weeks only.

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Class/Program Fees

1. Class Fees – Instructors are responsible for setting their own class fees. The supervisor

will provide assistance on current market conditions. The contract instructor and

supervisor can negotiate a final fee. The Instructor will receive a negotiated percentage

of the enrollment fees collected by the City for course(s) taught by the instructor. Non-

resident fees and late fees, described below, are not included in the calculation of the

enrollment fees.

2. Non-Resident Fees – The City of Coppell imposes a non-resident fee to individuals who

do not reside in the City of Coppell. The non-resident fee is automatically added to the

enrollment fee. Instructors do not receive a percentage of the non-resident fee portion

collected.

3. Other Surcharge Fees – For all classes at The CORE there is a $5.00 late fee imposed

if a student registers within 6 days prior to start of the class or after the class has already

begun. Instructors do not receive any portion of this fee.

4. Supply Fees – A supply fee is any fee that is not charged by The City of Coppell and is

collected and payable directly to the instructor. These fees are typically consumable

items the student benefits from in the class. These fees are never collected, nor charged

by, The City and are the sole responsibility of the instructor to collect. It is important that

supply fees are listed with the course description and in all promotional media.

5. Discounts – Instructors, in coordination with the supervisor, may offer discounts and/or

incentives to students to register for classes. Some discounts may include, but not

limited to, multiple family or sibling discounts, multiple class discounts, new student or

trial offers, etc. Keep in mind that discounts may lower instructor compensation for the

class or camp and are only permissible with approval by the supervisor.

6. Prorated Fees – Coppell Parks and Recreation does not prorate program fees. This

means when a student signs up for a class after it has started, the student is expected to

pay the full class fee for that class. If a student misses a class due to their own actions,

they will not receive a prorated portion of their fees returned. If a class is cancelled due

to an instructor’s illness or inclement weather, every effort will be made to hold a

makeup class. If a makeup class cannot be given, a prorated portion of their registration

fee will be returned to the student. It is at the discretion of the supervisor, in consultation

with the instructor, that some exceptions can be made to prorate a class fee for a

student.

Instructor Payment

The City of Coppell pays the contractor based on the enrolled participants and the negotiated

percentage of the set class/program fee after any refunds or transfers have been made.

Payment process will begin the last week of a program. The City of Coppell finance department

has a 30-day requirement to pay all invoices, however, every effort is made so that instructors

are paid within 10 days following the last week of classes. Checks are processed through EFT

(Electronic Fund Transfer) and are deposited directly into your bank account. The City of

Coppell is not responsible for any delays of funds once it has been sent to your bank. Please

check with your bank as to the availability of funds into your account once they have been

received by your bank.

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Managing your Class/Program

1. Class/Program Rosters – A list of all course participants can be retrieved online

through our registration system, ActiveNet, or you may contact the front desk for a

roster. Please take attendance during each class/program meeting using an attendance

sheet verifying everyone in attendance is listed on roster. For a step by step process on

accessing ActiveNet, please see the section titled “ActiveNet” in this handbook.

2. Class/Program Cancellation – The contractor must contact the supervisor if there is a

need to cancel or reschedule a class/program. It is the contractor’s responsibility to

contact all participants to let them know of the cancellation. Failure to notify the

supervisor and participants in the event of a cancellation may jeopardize future

agreements with the City. If the class/program does not meet the minimum number of

participants pre-established by the instructor, cancellation may be considered within 6

days prior to the start of the class/program. It is the expectation that the instructors

check the class/program enrollment prior to the start of their class/program and discuss

with the supervisor if a cancellation should occur. If the decision is made to cancel the

class/program, The Parks and Recreation staff will contact all participants and process

refunds.

3. Class/Program Changes – The Parks and Recreation Department alerts students to

changes in dates or class/program time by including class/program dates, holidays, and

planned absences in promotional materials and on their receipt. However, if the changes

occur after publication, instructors are also expected to remind students of deviation

from the regular class/program format with signs and verbal announcements at the

beginning and end of activity the week before the expected change.

4. No Shows – If a participant does not show up for the first class/program, please give the

participant a call to remind him or her of the next class/program, if you have multiple

class/programs. It is the participant’s responsibility to remember the

class/programs/camps that they have signed up for, but it is good customer service to

call your participants (phone numbers are printed on the course attendance sheet).

5. Refund and Satisfaction Guaranteed Policy – We stand behind the quality of our

programs. If a participant is not satisfied with a class/program for any reason after

attending the first program meeting, they may request for a full refund or transfer. After

the second program meeting they may request a pro-rated refund. All refund requests

must be made prior to the end date of the program. Refund requests for one-day

programs must be made 24 hours in advance.

6. Room Set-Up and Clean-Up – Each instructor is responsible for the class/program set-

up and clean-up of the facility and/or park site. Most facilities are equipped with tables

and chairs. If such equipment is used during a class/program, it is expected that each

instructor will stack all chairs and tables and put the equipment in the appropriate place.

The instructor should arrive early enough to have the room set-up by the class/program

start time and allow enough time after the class/program to make sure the facility is

cleaned and returned to its previous condition. Instructors are only allowed in the

facilities for the time reserved for their class/program. Each class/program is given at

least 15 minutes to set-up and 15 minutes to clean-up. If more time is needed, please

contact the supervisor and it can be discussed. Instructors are responsible for making

sure the facility is completely secure at the end of the class/program, this includes

checking any exterior doors located in your classroom.

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Additional Room Regulations

White boards must be

cleaned after use

No tape is allowed on

painted surfaces

Remove all items

temporarily hung from

ceiling or windows

Tables wiped down

completely

Lost and found items

should to be given to front

desk staff - not left in room

Broom, dust pan and

cleaning wipes are

available in closet

7. Storage – Our facilities have limited storage and space is rarely granted. items may not

be stored in the facility without discussion with supervisor and a signed storage waiver is

on file.

Customer Service and Instructor

Expectations

Instructors are encouraged to treat all staff at City facilities, volunteers, fellow instructors,

customers, and our partners, with professionalism. Please be courteous, friendly, thoughtful,

efficient, and considerate to everyone. Contractors are required to provide excellent customer

service, take pride in where they work, and what the class/programs they offer.

It is expected that all instructors are prepared for class, arrive in a timely manner, and prepared

to teach a top-notch program. As is expected when teaching children’s classes, not all students

perform at the same level or in the same way. We ask that you be fair with all students and do

not show favoritism. As with any group classes, not all students progress at that same pace.

Please do not let a student take up extended amounts of your time so that you cannot give

equal attention to the remainder of the participants. The class needs to be a positive

experience for everyone. In these situations, some students may not be ready or experienced

enough to handle the class level. We expect you to speak with the parent/guardian as to the

circumstances of the situation and resolve the issues. This can be done by changing the child’s

class level, adjust teaching style, or remove participant from program and issue a refund. If the

situation is a behavioral issue, parents must be notified immediately. Supervisor should be

notified when first signs of behavioral issues begin and he/she will assist in the decision if the

child needs to be removed from the class and refund issued.

Safety and Emergencies

Above any other consideration, the Parks and Recreation Department, and by extension its

contractors, must provide for the safety of the people who use its facilities and participate in its

programs. You must use your best judgment at all times, and think safety constantly and

exercise all possible measures to prevent accidents, injuries, and/or damage to property.

Participants should also be encouraged to think in terms of safety. Take the time to speak

directly and concisely, and explain to participants why they should be doing something.

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1. Minor accident/incident – Notify front desk immediately. First aid supplies are

available at the front desk. If at The CORE, aquatics staff will respond to the situation,

as they are the first responders in the facility.

2. Major accident/emergency – In the case of a potentially life-threatening emergency,

dial 911 immediately and send for help from the front desk. If at The CORE, aquatics

staff will assist in the situation and try to stabilize the emergency prior to arrival of

medical emergency crews.

3. Accident/Incident Reporting – An official report must be filed by instructor prior to

leaving the facility the day of the accident/incident. A report form can be obtained from

the front desk or aquatics staff, and staff will assist in completing the forms. Make sure

you have names involved in the situation and full details of what occurred, facts only.

Supervisor must be notified of all accidents, incidents, and emergencies immediately.

4. AED – AED’s are located in each facility. Please make sure before beginning you know

where these are located in the facility.

5. Fire Extinguishers – Fire extinguishers are located in each building. Please become

familiar with their locations.

6. Inclement Weather – In the event of inclement weather, all participants and staff will be

moved to designated safe areas of the building. Front desk staff or supervisors will

escort group to designated areas where they will stay until emergency situation has

passed.

7. Evacuation – If the facility needs to be evacuated for an emergency situation, everyone

will be taken to the facility safe zone. Prior to returning to the facility, minors may be

released to their parents or authorized guardian only. Instructors are required to take

class/program roster with them when they leave the facility as this will contain parents

information.

ActiveNet

ActiveNet is the registration software we use for programming. Instructors can download their

rosters prior to the start of class/program. Instructors can view and print rosters (with contact

information), attendance sheets and view activity text.

1. Go to the website: www.coppellactivities.com

2. Click the sign in button. Username and Password: You have a temporary username and

password. Username is: first initial last name (i.e. jdavis). Password is: last name (i.e.

davis)

3. Click on “My Account” in the upper right corner to access all your personal information

as well as instructor information.

4. Check your personal information and change your password. In the “Personal

Information” section, you can change your password, update your address, birthday, etc.

5. Check your instructor information! This is where you can pull together rosters,

attendance sheets, etc.

6. To pull a simple class/program roster, follow the steps below:

a. Click on “Roster-Brief”

b. Select the class/program you want to create a roster for (you can select one or

multiple)

7. Scroll through the options, including “output type”

8. Click on Run Report

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Forms

• Independent Contractor Application

• Class/Program Proposal

• Contract Questionnaire

INDEPENDENT CONTRACTOR APPLICATION

Name of Business or Organization:_________________________________________________________

Name of Primary Contact:_________________________ Phone Number:_______________________

Address:_____________________________________ City:_________________State: ___Zip:_________

Email Address:_________________________________ Website Address:_________________________

BUSINESS INFORMATION

How is your business classified?  Individual/sole proprietor  Corporation  Partnership

How long has your business been open? Do you have employees?  Yes  No

Describe the purpose of your business and what it does:

INSTRUCTOR INFORMATION

Are you Over 18 Years Old?  Yes  No

Do you possess a valid driver’s license?  Yes  No

Are you a citizen of the United States or do you have a legal right to work in the US?  Yes  No

Bilingual Language Skills: Language - ______________________  Speak  Write

Language - ______________________  Speak  Write

Check Highest Education Level:  High School Diploma/GED College:  1  2  3  4

Post Graduate:  Masters  Doctorate

Licenses/Certificates (A copy of each certificate will be required to be turned in with a signed contract):

1) ________________________________ Issued By:________________________ Expire:______

2) ________________________________ Issued By:________________________ Expire:______

3) ________________________________ Issued By:________________________ Expire:______

List Current Instructors:

1) ________________________________ 2) _______________________________________

3) ________________________________ 4) _______________________________________

REFERENCES

Please provide a list of three (3) references who can speak to your work and/or experience as it relates to your

class proposal:

1) Name:______________________________How long has this person know you?___________

Telephone Numbers:___________________________________________________________

Email:________________________________ Relationship:____________________________

2) Name:______________________________How long has this person know you?___________

Telephone Numbers:___________________________________________________________

Email:________________________________ Relationship:____________________________

3) Name:______________________________How long has this person know you?___________

Telephone Numbers:___________________________________________________________

Email:________________________________ Relationship:____________________________

LEGAL

By my signature below, I acknowledge that this Questionnaire is intended to assist the City of

Coppell in complying with various federal and state laws. I also understand that false or

incomplete information may cause the City to be unintentionally noncompliant with such laws.

By my signature below, I certify that my answers to this Questionnaire are accurate and complete

and I agree to immediately notify the City’s Human Resources Department, in writing, if there is

a material change in the facts as presented in the Questionnaire.

_______________________________________________________ __________________________

Service Provider’s Printed Name, Title Date

_______________________________________________________

Signature

RECREATION PROGRAM PROPOSAL

Submittal Date:_________________________ (Please provide separate forms for each class/program)

Name of Business or Organization:_________________________________________________________

Name of Primary Contact:_________________________ Phone Number:_______________________

Address:_____________________________________ City:_________________State: ___Zip:_________

Email Address:_________________________________ Website Address:_________________________

CLASS DESCRIPTION

Proposed Class Title:

Class/Program Description for Activity Guide: (Include benefit statements and “you” language, 50 words max)

CLASS PREFERENCES

Type Program:  On-going Sessions  Camp  Periodically or One-time Special Program

Preferred Days of the Week:

 Monday  Tuesday  Wednesday

 Thursday  Friday  Saturday

 Sunday

Preferred Times:

 Mornings between 6am – 12 noon

 Afternoons between 12pm – 5pm

 Evenings between 5pm – 9pm

Preferred facility/classroom needed:  The CORE  Senior Center  Biodiversity Educ. Ctr  Park

CLASS INFORMATION

AGE GROUP

 PreSchool (2-5 yrs)  Teens (13-17 yrs)

 School Age (6-12 yrs)  Adults (18 & up)

ACTIVITY CATEGORY

 Camps  Health & Fitness  Enrichment

 Dance, Music & Performing Arts  Workshop

 Arts & Crafts  Special Interest  Other

Age Minimum:

Age Maximum:

Minimum Class

Enrollment:

Maximum Class

Enrollment:

Will contractor named above be the instructor for this class?  Yes  No

If not, please list instructor’s name(s):

CLASS FINANCIALS

Compensation Requesting:

 Percentage of fees - 70 %

Suggested Course Fee (should account for the

“contractual percentage/rate split” between instructor

and City) $_______________

Any other associated fees tied to this program

(supplies, uniforms, recital fee, etc.)? How much

and what for?

Are there any discounts tied to this program (discount

for multiple registrations, partial week, daily rate, sibling

registrations, etc.)? How much?

CityofCoppell‐Parks&RecreationDepartment

IndependentServiceProviderQuestionnaire(revisedAug.1,2011) Page1

CITY OF COPPELL

PARKS & RECREATION DEPARTMENT

INDEPENDENT SERVICE PROVIDER QUESTIONNAIRE

Service Provider’s Name: ________________________ Date: ________________________

Your answers to this questionnaire will be used by the City of Coppell’s Human Resources

Department to determine whether you are properly classified as an independent contractor or as

an employee. This determination is necessary to ensure that the City complies with federal tax

withholding and reporting laws as well as other requirements governing employees and

independent contractors. If you need more space to answer any of the questions, you may attach

additional pages as necessary.

1. Please describe the types of classes you desire to teach

2. Is your business a company, or are you providing the services in your individual capacity?

3. Do you have a business card?

If so, please attach.

4. Do you advertise or otherwise promote your services?

If so, please describe.

Do you have a website?

If so, what is the URL?

5. Do you have a brochure or other marketing materials?

If so, please attach.

Yes No

Yes

CityofCoppell‐Parks&RecreationDepartment

IndependentServiceProviderQuestionnaire(revisedAug.1,2011) Page2

6. Please list any certifications or licenses you hold related to the classes you wish to teach and

the certifying organizations. Attach copies of the listed certifications and licenses.

7. What supplies or equipment do you need to teach these classes?

Who will supply these items?

8. Who will actually teach the classes?

If you (or the scheduled instructor) is sick or is otherwise unable to teach a scheduled class,

how will the absence be handled? Will a substitute instructor be provided? Please provide

details.

9. Do you perform criminal background checks on your employees/instructors?

If so, what criminal records do you check?

If so, how often are background checks performed?

If so, who conducts the criminal background check?

Note: Service Providers must provide the City with documentation evidencing successful

completion of a City-approved drug and alcohol test and a City-approved criminal history

background check on all individuals who will teach classes or provide other services to the

City. This documentation must be provided to the City’s Human Resources Department no

later than 5 business days before the class or service is scheduled to begin.

Yes No

CityofCoppell‐Parks&RecreationDepartment

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10. Describe how you desire to be compensated and in what amount(s)?

11. Have you ever been an employee of the City?

If yes, answer the following:

Dates of employment –

Position title –

Rate of pay –

Describe duties/work performed-

12. Have you performed work as an independent contractor for cities or companies other than the

City of Coppell within the last 2 years?

If yes, identify them and estimate the number of hours worked for each during the

prior 2 years.

If the services were different than the classes you will be teaching for Coppell,

please describe.

13. What monetary or other investments have you made to your business?

14. Do you have insurance coverage in connection with the classes you will teach for the City,

e.g., worker’s compensation or general liability?

If yes, please describe, including the name of the insurance carrier and the organization

providing the coverage.

Yes No

CityofCoppell‐Parks&RecreationDepartment

IndependentServiceProviderQuestionnaire(revisedAug.1,2011) Page4

If yes, you must attach copies of the relevant policies, certificates of coverage, and other

Fill Online, Printable, Fillable, Blank CORE Independent Contractor Packet.1018 (City of Coppell) Form

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Fillable CORE Independent Contractor Packet.1018 (City of Coppell)

Fill Online, Printable, Fillable, Blank CORE Independent Contractor Packet.1018 (City of Coppell) Form

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