Fillable IndContractorFormRevisedFeb2019 SANTA BARBARA CITY COLLEGE

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IndContractorFormRevisedFeb2019 SANTA BARBARA CITY COLLEGE

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SANTA BARBARA CITY COLLEGE
CONSULTANT/INDEPENDENT CONTRACTOR FORM
It is essential that all of the requested information be filled in completely and must be received in the Human
Resources Office by the deadline date listed on the Board Agenda Calendar provided. Please
understand that the information collected here will be used to make a determination that may have to be
defended by the college’s legal and business department if audited by the IRS or the State EDD, where
applicable. Please be as complete and accurate as possible. It is very important that you include any and all
documentation requested. If any documentation is missing or unavailable, it may delay approval of the work
agreement. OUT-OF STATE VENDORS AND CONSULTANTS MUST PRE—SIGN Forms 587 and a
W-9 pursuant to CA Tax Laws. No one can work until those forms, available from Accounting
are signed where needed and until the consultant is Board approved.
Name of Hiring Manager (print)
Title of Hiring Manager
Department (print)
Board Date:
Budget #:
Amount: $
Indicate fund source:
Dates of Service:
Name of Contractor
Phone No.
Social Security #
Tax ID #
Company Name, if applicable:
Address:
Email Address:
This portion to be completed and signed by contractor
1. If contractor is operating under a business name, is the business a
1a. Sole Proprietorship?
Fictitious name statement? _______ Number: ______ Tax ID #________
1b. Corpor
ation?
Date of incorporation: ___ Type of Corporation ____________
Do you pay yourself on a Form W-2?
2. Unique expertise
If “yes” describe
Yes
Yes
Yes
Yes
No
No
No
No
3. Are you a relative or domestic partner of anyone who works at Santa Barbara City
College? If yes, please list their name/s, relationship, and department in which they
work.
Yes No
4. Have you ever been an employee of this college? If Yes, please give dates and
state the nature of that work.
Yes No
5. If the answer to #4 is Yes, are the services that you will be providing to this college Yes No
similar to those you performed as an employee?
If No, in what ways are they different? _________________________________________________
_____
___________________________________________________________________________
________________________________________________________________________________
General
6. List licenses to do business in the area of expertise for which you will be a
consultant, if applicable?
Business license #: ________________ Professional license #:______________
Musician/Actors Union #: _________________Other ______________________
Yes
No
7. Are you performing similar consulting services for other companies at this time?
Yes
No
8. Please attach a copy of your business card, letterhead, brochure, etc., that you
use in your business.
I understand as a contractor that any work done by me pursuant to this agreement is work for
hire and is the exclusive property of Santa Barbara City College. I agree to submit all work to
the college promptly upon completion of each project specified in this agreement and
understand that final payment is not due until the college has received my completed work.
S
igned: ________________________________________________ Date: ____________________
Contractor
T
his portion must be completed and signed by College Manager and must be signed by area
dean and vice president:
1. S
ervices to be performed:
Please describe the work the contractor will be performing. Specify the expertise for which
the contractor been selected. Include a narrative description of the services and describe any
materials, reports, surveys, etc., that are to be furnished by the Contractor. Attach additional
pages, if needed). Sufficient detail is required for the college to determine whether or not t
o
ap
prove this individual or entity as a contractor. Inadequate information may result in delay in th
e
start of work by the Board approved contractor. PLEASE DO NOT USE ACRONYMS.
I propose that the above Contractor shall perform services for the College as set forth below:
_
_____________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
2. I propose payments in consideration of the services and materials needed in order t
o
pe
rform as noted in paragraph1:
College shall pay an amount not to exceed $ ________________ to Contractor during
term of this Agreement. Payment of the aforesaid sum shall be made in the following
manner. List any benchmarks that will be required for payment.
3. Will this college provide training in order for Contractor to provide service? Yes No
If “yes” provide detail.
4.
Will the manager on the project supervise Contractor? Yes No
If “yes” provide detail.
5. W
ill the college have the right to require interim reports from Contractor
on this project? Yes No
6. Will this college expect Contractor to perform services personally? Yes No
7. Will Contractor supervise employees of this college? Yes No
8. Will Contractor supervise students of the college? Yes No
9.
Will this college require Contractor to work at specific or set hours? Yes No
10. W
ill this college be exercising any control over how Contractor performs services? Yes No
If “yes” provide detail.
11. Will the college reimburse Contractor for material, travel or expenses? Yes No
If ”yes” receipts must be retained by hiring manager. The amount approved in this
must designate funding to cover all expenses.
12. W
ill Contractor use his/her own tools, equipment or materials? ________%
or the college’s? ________%
If “yes” provide details.
The college does not provide office space, computers, or support services to contractors.
13
. Can this college terminate the agreement for any other reason than Yes No
non-performance?
14. Is this contract in excess of $25,000 and is it to be paid from a Federal award? Yes No
If
yes, is this contractor suspended or debarred per Excluded Parties List System at www.epls.gov
Yes No
I declare that I have no financial interest in the hiring of this Consultant/Contractor.
Si
gned: ______________________________________________ Date: _____________________
(College Manager requesting services)
Print Name: __________________________________________
Si
gned: ______________________________________________ Date: _____________________
(Area Dean)
Print Name: __________________________________________
Si
gned: ______________________________________________ Date: _____________________
(Area Vice President)
Print Name: __________________________________________
Si
gned: ______________________________________________ Date: _____________________
(Superintendent/President)
Print Name: __________________________________________
This portion to be completed and signed by Business Services or Human Resources. If
contractor is a corporation and/or payment will equal or exceed $25,000, a separate written
agreement must be provided.
_______________________________________________ is approved for hire as an independent
contractor based on his/her representations and the representations of the department manager.
A completed Agreement ________ will be required.
________ will not be required.
Si
gned: ______________________________________________ Date: ___________________
V.P. Business Services or V.P. Human Resources
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Completed 11 March 2020

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