Facture - Invoice
Représentant - Representative
Quantité - Quantity
Bon de commande - PO No.
Description
Date de service - Service Date
Prix unitaire - Unit Price
Terme de payment - Payment Term
Total
Pour l’utilisation de la Faculté de Médecine seulement - For Faculty of Medicine use only
Gabarit de facture fourni par l’Université d’Ottawa | Faculté de médecine | Service des achats et réception
Invoice template provided by the University of Ottawa | Faculty of Medicine | Purchasing and Receiving Services Version 1.0 - NOV-2015
Total partiel - Subtotal
Nᵒ de facture - Invoice No.
FOAP
Statut du service - Service Status
Approbation - Approval
SIGNER - SIGN
Instruction spéciale - Special Instruction
Autre - Other
Date
No HST - HST No.
Taxes
Total
Adresse de facturation - Billing Address
Fournisseur de services - Service Provider
Adresse de livraison - Delivery Address
IMPRIMER - PRINT
Dr. Justin Talor
10035 39th AVE NE
2
Seattle WA
2021-02-05
98125
Same as above
1hr
Advances in Biomedical research
500.00
500.00
Seminar guest speaker
500.00
500.00
Complet - Complete
154505
GST/HST DECLARATION FORM
Last revision March 2017
Financial reporting period: January to December 2020
Service Provider Complete Name
Justin Taylor
HST for non-clinical services to the university
The U of O has obtained expert accounting and legal opinions regarding non-clinical services provided to the Faculty
of Medicine. The program requires that any individuals with a self-employed status as per the Canada Revenue Agency
(CRA) RC4110 form, offering professional services to the University must individually invoice the University of Ottawa.
It is the responsibility of each individual to properly charge, collect and remit the HST to the Canada Revenue
Agency.
1. AS A SERVICE PROVIDER, I DECLARE:
I confirm that my total source of all revenues for this specific type of service from worldwide taxable supplies
exceeds $30,000; and I am registered to charge, collect and remit GST/HST. Thus GST/HST shall be
charged and I am eligible to claim (Input Tax Credit) ITCs. I acknowledge full responsibility to charge, collect
and/or remit the GST/HST on taxable supplies of goods and services.
GST/HST Number: ______________________________
I confirm that my total source of all revenues for this specific type of service from worldwide taxable supplies
does not exceed $30,000; and I am voluntary registered to charge, collect and remit GST/HST. Thus
GST/HST may be charged and I am eligible to claim (Input Tax Credit) ITCs. I acknowledge full responsibility
to charge, collect and/or remit the GST/HST on taxable supplies of goods and services.
GST/HST Number: ______________________________
I confirm that my total source of all revenues for this specific type of service from worldwide taxable supplies
does not exceed $30,000 and I am not registered for a GST/HST account with the CRA Canada
Revenue Agency. Thus GST/HST will not be charged to the client and I cannot claim ITCs. I acknowledge
full responsibility to collect and/or remit the HST to the CRA if requested by the Government of Canada. I am
responsible to verify my status with CRA before filling out this form.
GST/HST DECLARATION FORM
Last revision March 2017
2. SERVICE PROVIDER PAYMENT INFORMATION
PAYMENT REMITTED TO
Please check Payee Status and complete applicable
section below.
Individual Organization
INDIVIDUAL PAYEE STATUS
If checked payee status “Individual”, indicate Legal Name, SIN Number and complete address, to remit
payment to.
Individual (Legal) Name
Justin Taylor
SIN Number
Complete Address
10035 39
th
Ave NE, Seattle, WA, USA, 98125
ORGANIZATION PAYEE
STATUS
If checked payee status “Organization”, indicate Legal Name and complete address, to remit payment to.
Organization (Legal) Name
Complete Address
I certify that I can legally bind this declaration to the Organization
I certify that the information given on this form and its attachments is correct and complete.
____________________________________ ____________1-22-21_____________
Signature - Service Provider
Employment Status
This table summarizes employees and/or Self-Employed individual characteristics. Upon completion, the worker's employment status is determined.
Name of worker:
Worker's social insurance number:
Has the SIN been obtained? Yes
Name of Ocer:
No
If not, did you document a proof of refusal (this is mandatory)? Yes No
Factors of RC4110
True False
N/A
Control
1. The payer controls the result of the work and the method used to do the work.
2. The payer determines and controls the method and amount of pay in an employer-employee relaonship.
3. The worker requires permission to work for other payers while working for you.
4. The worker receives training at the expense of the payer.
5. If the work schedule is irregular, you are the worker's priority.
6. The worker cannot choose when he or she will provide his or her services.
7. The worker cannot refuse work from the payer.
8. The payer performs monitoring in the acvies surrounding the work.
9. The payer decides on the territory to be covered for the work.
10. The payer decides on the reports to hand in (wrien or verbal).
Tools and Equipment
1. The work is done in the payer's workplace.
2. The payer supplies the tools and equipment.
3. The payer is responsible for repair maintenance and insurance costs.
Subcontracng work or hiring assistants
1. The worker cannot hire helpers or assistants.
2. The worker does not have the ability to hire replacements.
Financial risk
1. The worker is reimbursed for any operang expenses.
2. The worker is not nancially liable if he or she does not full the obligaons of the contract.
3. The payer determines and controls the method and amount of pay.
4. The worker is not hired for a specic job (he or she has dierent tasks and projects).
5. The worker receives protecon or benets from the payer.
6. The worker does not adverse and does not acvely market his or her services.
7. The payer covers delivery and shipping costs for the worker.
8. The payer assumes responsibility for ensuring that guarantees relating to materials are honoured.
9. The payer guarantees the quality of work.
Responsibility for investment and management
1. The worker has no capital investment in the business.
2. The worker cannot have his or her own sta.
Opportunity for prot
1. The worker is paid a regular salary (does not incur expenses by performing the services).
2. The worker does not have the chance of prot or risk of loss.
Total columns (the higher number determines the worker's status)
True = Employee False = Self-Employed
Phase 1 Page 2
Dr. Justin Taylor
Blanche Dinelle
|
Université d’Ottawa University of Ottawa
ADVANCES IN BIOMEDICAL
RESEARCH SEMINAR SERIES
LA SÉRIE DE SÉMINAIRES SUR LES PROGRÈS DE LA
RECHERCHE BIOMÉDICALE
"Analyzing and Engineering Antigen-specific B cells”
Tuesday, February 16, 2021
Mardi 16, février, 2021
11 a.m. to 12 p.m.
11h à 12h
Virtual Zoom Seminar
Séminaire de Zoom virtuel
Dr. Justin Taylor
Assistant Professor, Immunology and Vaccine Development Program, Vaccine and
Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA/
Professeur adjoint, programme d'immunologie et de développement de vaccins,
division des vaccins et des maladies infectieuses, Fred Hutchinson centre de
recherche sur le cancer Seattle, WA
Faculté de médecine/Faculty of Medicine
Études supérieures et postdoctorales
Graduate and Postdoctoral Studies
med.uottawa.ca gad.med@uottawa.ca
med.uOttawa.ca/grad grad.med@uOttawa.ca