WESTERN CAROLINA UNIVERSITY

Transcription

1 (1) (2) STANDARD AGREEMENT FOR INDEPENDENT CONTRACTOR This form must be executed in its entirety by both the Independent Contractor and the person specified in Policy 62 PRIOR to the Independent Contractor's providing a service or performance for the University. Failure to obtain the required signatures in advance may result in non-payment by the University. In that event, the Accountable Officer may be personally liable for payment to the Independent Contractor. If the Independent Contractor is a non-resident alien, contact the University Controller for guidance because there are IRS regulations which must be complied with in order to pay a non-resident alien. Check Distribution Details Date Check Needed: Date of Event: (Note: State law prohibits payment prior to completion of services.) Mail to Independent Check will be picked up by: Name Phone No. Purchasing Controller HR The undersigned Independent Contractor (hereinafter "IC") and Western Carolina University (hereinafter "University) agree to the following terms and conditions for the performance of certain tasks as described below. 1. IC is identified as follows: Name: form Type of Entity (check all that apply): Sole Proprietorship Government Entity (State or Federal) Corporation Partnership Non-Profit LLC Other - Specify Enter LLC Tax Classification: D = Disregarded Entity; C = Corp.; P = Partnership: Principal Place of Business: Permanent Address: Business Telephone: If any permanent part of your business is located in North Carolina, and not listed as "Principal place of business" in the previous section, please provide this address also: University Representative: have the Independent Contractor complete an IRS form W-9 to certify either a social security number or employer identification number. Do not scan or the form W-9. Deliver it to the Controller's office via mail. North Carolina Secretary of State Certificate of Authority ID#, if out-of-state corporation or LLC : Residency status (individual): U. S. Citizen Resident Alien Non-resident Alien 2. Description of tasks to be performed by IC: 3. Will any revenues be generated in connection with event? yes no (If yes, please complete a and b below.) a. Please detail source(s) of revenue (ticket sales, sponsorships, private gifts, etc.) b. Fund # in which proceeds will be deposited: 4. Total Price: Does this amount include travel expenses? Subject to 4% NC Withholding (Yes or No) If no, please send an to controller@ .wcu.edu indicating a travel reimbursement will be submitted for the named independent contractor upon completion of services. yes no May be subject to withholding if payment is to an out-of state individual or entity for entertainment, a speech, or performance. Page 1 of 5

2 Payment Detail: Fund & Account: Amount: Accountable Officer or Designee Approval (Printed Name) (Signature) *If more accounts are required, please use a separate sheet to list them. 6. Official University Representative (Departmental): Phone No. Please send two copies of this first page when using in conjunction with an agency, entertainer, or other entities contract. 7. Indicate any Riders which are to be made part of this agreement: 8. IC: University: Additional Agreement Provisions: This agreement begins upon execution by both parties and shall end on provided for herein. unless terminated as 9. The Payment to a non-resident IC may be subject to 4% backup withholding in accordance with North Carolina General Statute G.S It is understood that the IC executes this agreement as an Independent Contractor and is not an employee of the University, and that IC shall have the exclusive control over the means, methods and details of fulfilling its obligation under this contract. IC agrees to perform and discharge all obligations of an Independent Contractor under any and all laws, whether existing or in the future, in any way pertaining to the tasks hereunder, including but not limited to Social Security laws, Workman's Compensation Insurance, income taxes, State Employment Insurance, taxes or contributions, Public Liability Insurance; and IC will hold University harmless against all such laws as well as against all union claims for welfare payments. No payroll tax shall be withheld or paid by University on behalf of IC or the employees of IC. No Worker's Compensation Insurance shall be obtained by University concerning IC or IC's employees. The parties agree that this agreement was entered into in the State of North Carolina and that the laws of North Carolina shall govern this contract as to interpretation and performance. It is further agreed that the place of this contract, its situs and forum, will be Jackson County, North Carolina, and in said county and state will all matters, whether sounding in contract or tort relating to the validity, construction, interpretation and enforcement of this contract, be determined. The parties agree that the agreed price for the engagement as set forth in paragraph 4 includes travel expenses, accommodation expenses and any and all other expenses, costs and remuneration the parties have agreed to unless otherwise provided for in paragraph 7. The University may terminate this contract at any time by notice in writing from the University to the Contractor. In that event, all finished or unfinished documents and other materials shall, at the option of the University, become the University's property. If the contract is terminated by the University, as provided herein, the Contractor will be paid in an amount which bears the same ratio to the total compensation as does the service actually performed to total service set forth in the Agreement. Notwithstanding, the IC shall not be relieved of liability to the University for damages sustained by the University by virtue of any breach of this agreement or failure to perform, and the University may withhold payment to the IC for the purpose of set-off until such time as the exact amount of damages due the University from such breach or failure can be determined. Page 2 of 5

3 1 This contract will not be used for advertising by IC without prior approval of the University. 16. This contract has been entered into compliance with state and federal antitrust laws Neither party shall be responsible to the other for any losses resulting from the failure to perform any terms or provisions of this Agreement if the party's failure to perform is attributable to war, riot or other disorder, strike or other work stoppage, fire, flood, storm, illness, or any other act not within the control of the party whose performance is interfered with, and which, by reasonable diligence, such party is unable to prevent. By signing this form, the Independent Contractor certifies that, as of the date of acceptance, it is not on the then-current version of the Iran Divestment Act List. Contractor agrees to not contract with any person to perform a part of the contractual work, if, at the time the Contractor enters into a subcontract, that person is on the then-current version of the Iran Divestment Act List. Contractor further agrees to notify the University if, at any time during the contract term, including any renewal terms, it is added to the Iran Divestment Act List. (See nctreasurer.com for the most current list.) IC: INDEPENDENT CONTRACTOR (Print or type name of IC) Contracts 9,999 or less Agreed by (IC or Authorized Signature) Agreed by Responsible Dean, Chief of Staff or Vice Chancellor Contracts 10,000 or greater REQUIRE signature of Chief of Staff or Vice Chancellor. Page 3 of 5

4 DETERMINATION OF ELIGIBILITY FOR INDEPENDENT CONTRACTOR Payee Name I. Eligibility No Yes 1. Is the payee a non-resident alien? (if no, go to question 2.) Go to #2 Go to a. a. If yes, will the payee be here on an A-1, F-1, G-1, J-1, M-1, Q-1, or TN Visa? **If 1a is yes, see last page of form for requirements to be met before payment can be made and complete the rest of this form. **If 1a is no, stop here. The individual may not be contracted with or paid compensation for any type of service. 2. Is the payee an employee of any agency of the State of North Carolina (see list of agencies on the last page of this form)? If yes, you must STOP here. The individual cannot be paid as an independent contractor. He/she must be paid through dual employment as provided in the State Budget Manual. II. Determination of Independent Work Status (A "yes" answer indicates an employer/employee relationship and payment must be made through payroll.) No Yes 1. Is the individual working exclusively for Western Carolina University? Are the services of the individual integrated into the organization? For example, are you hiring someone to teach a credit course? (Normally performed by WCU employees?) Is the WCU dept. providing long-term assistance to the individual such as additional personnel support, supplies, equipment, etc? Is the WCU dept. providing on-going training and direction concerning how to complete the task? Does the prospective payee/independent contractor report to a WCU staff member who has the right to change HOW the individual does their work? Is there a regular on-going relationship with the prospective payee/independent contractor? For example, are you hiring the individual for more than a one time task? Is the prospective payee/independent contractor using experience or expertise gained as a previous employee of WCU to provide the independent contractor services? Can the independent contractor quit prior to completion of the project without incurring any legal liability? Will payment to the payee include a separate reimbursement of travel expenses? Page 4 of 5

5 III. Non-resident alien only 1. Have the person complete a form W-8BEN 2. Will you claim treaty benefits? yes no If yes, what country? 3. VISA type? 4. Anticipated arrival date in U.S.? Anticipated departure date from U.S.? I certify that the information provided above concerning my eligibility is correct: Payee Signature (must be payee named above) Phone # Date If you have any questions regarding this page, refer to Appendix V, VISA/PAYMENT MATRIX, page 29 of the North Carolina Office of State Controller Policy and Procedures Pertaining to Payments and Compensation of Foreign Nationals, Governments, and Corporations. Use link below: Page 5 of 5