Fillable OAK023381 - Schedule M Part B

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OAK023381 - Schedule M Part B

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SCHEDULE M
Revised 7/20/00
109344.1 Page 1 of 2
PART B: INDEPENDENT CONTRACTOR QUESTIONNAIRE TO BE COMPLETED
BY REQUESTING DEPARTMENT
Contracting Dept. or Agency__________________________________________________________
Dept. or Agency Liaison_____________________________________(Ext.______________)
Name of Contractor___________________________________________________________
Contractor EIN or SSN________________________________________________________
To be completed by the City Department or Agency, and attached in completed form with Part A
(completed by the Contractor) and submitted for written approval to the City Attorney before
submission of contract.
1. Briefly describe the work to be performed by the Contractor. ________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
2. Will this contract require the Contractor to personally perform all services or will the
Contractor have the option of assigning duties to his or her own employees or assistants?
________________________________________________________________________________
3. Do you intend to give the Contractor instructions on how to do the work under the contract?
________________________________________________________________________________
4. Briefly describe the extent to which you are planning to supervise or oversee the work of the
Contractor. ___________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
5. Will the work of the Contractor end because this is a finite project or will it end because
there are not funds to support the continuation of the Contractor’s work beyond a date certain?
________________________________________________________________________________
6. Describe the extent to which the Contractor will work on or at City facilities or sites (rather
than in the Contractor’s own offices). _________________________________________________
________________________________________________________________________________
________________________________________________________________________________
7. Are all services to be performed by the Contractor clearly distinguishable from the duties
performed by any employee in any City of Oakland job classification?
________________________________________________________________________________
8. If your response to No. 7 is “No”, identify job classifications having material duties which
are similar. (Verify with OPRM if uncertain.) __________________________________________
________________________________________________________________________________
9. Will the Contractor be paid on an hourly basis? If yes, please state the amount per hour.
________________________________________________________________________________
Print Form
PART B: INDEPENDENT CONTRACTOR QUESTIONNAIRE (Continued)
109344.1 Page 2 of 2
10. Will the Contractor be paid on a total project basis? And, if the Contractor will be paid on a
basis other than hourly or by total project basis, please describe _____________________________
________________________________________________________________________________
11. Over how long a period of time will services under this contract be performed?
________________________________________________________________________________
12. Will the services require the Contractor’s full-time attention for any give day (6 or more
hours) or given week (30 or more hours) during the duration of the contract? If yes, please indicate
the approximate amount of time______________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
13. Describe the extent to which the City is requiring the Contractor to perform the services on
fixed days of the week or at fixed hours. _______________________________________________
________________________________________________________________________________
14. Will the Contractor be asked to keep hourly records and report time spent on the project by
the hour or portions thereof?
________________________________________________________________________________
15. Will the Contractor be reimbursed or expect reimbursement for expenses incurred in the
performance of this contract?
________________________________________________________________________________
16. Is the City expecting the Contractor to put in a minimum number of hours per week on the
project?
________________________________________________________________________________
17. Will the Contractor be expected to attend meetings scheduled by the City? If so, describe
the type and frequency of meetings. ___________________________________________________
________________________________________________________________________________
18. Is there is a reason why the City cannot or should not employ the person as a temporary
civil-service-exempt employee? If there is such a reason, briefly explain below:
________________________________________________________________________________
I VERIFY THAT THE ABOVE RESPONSES ARE TRUE AND CORRECT TO THE BEST
OF MY KNOWLEDGE.
____________________ ______________________________________________
Date Department or Agency Liaison
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OAK023381 - Schedule M Part B

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Completed 9 March 2020

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