Download short form personal services agreement

Research Foundation
University Foundation
Limited Use Independent Contractor Agreement
This limited Independent Contractor (I.C.) Agreement may be used when an employment relationship does not
exist, when the services are not continuous or of a type normally performed by an employee, and when the
following conditions exist:
1. The total compensation for an individual must be less than $600 in a calendar year, and
2. The work relationship meets IRS criteria for an I.C. (e.g., is in an established business and performing
services of an independent nature for multiple clients).
Name
SSN
Date
last 4 numbers
Address
Service to be Rendered
Date of the Service
Payment
Date and Nature of Prior Services to Foundation
Date of Last Payment Received from the Foundation
I understand that I am not an employee or agent of the Foundation, that as an Independent Contractor I am
solely liable and responsible for all Federal and State taxes, that I am not covered by Workers' Compensation or
Unemployment Insurance or eligible for any employer benefits, and that I agree to hold the Foundation and
University harmless from any liability resulting from work performed relative to this agreement. I further agree
to indemnify and/or defend the Foundation in any legal proceedings that arise out of services performed as a
result of this agreement.
I. C.’s Signature
I.C. must sign prior to beginning work
I certify that the above services were completed, that the approved payment is appropriate to the service
performed, and that the services were necessary and could not be performed by anyone currently employed by
the project.
Project Director’s Signature
Project Number
Date
Rev 2/2007