Laserfiche WebLink
110-23 Master Contract No.900973,Procurement Contract No.7485 . <br /> 4. Is the relationship between the County and the contractor intended ( ) ( ) <br /> to be ongoing? <br /> III. FOR CONSULTANTS, PROJECT MANAGERS,PROJECT YES NO <br /> COORDINATORS <br /> 1. Is the contractor being hired for a period of time rather than for a ( ) ( ) <br /> specific project? <br /> 2. Will payment be based on a wage or salary (as opposed to a ( ) ( ) <br /> commission or lump sum)? <br /> IV. FOR PHYSICIANS,PSYCHIATRISTS,DENTISTS, YES NO <br /> PSYCHOLOGISTS <br /> 1. Will the agreement be with an individual who does not have an ( ) ( ) <br /> outside practice? <br /> 2. Will the contractor work more than an average of ten hours per ( ) ( ) <br /> week? <br /> IF THE ANSWER TO QUESTION 2 IS YES, ANSWER <br /> QUESTION 3. <br /> 3. Will the County provide more than 20% of the contractor's ( ) ( ) <br /> income? <br /> 4. If the answer to either question 2, or if required, question 3 is NO, <br /> the entire answer is NO. <br /> A "YES" answer to any of the questions in Section II, or, if applicable, Sections III or IV <br /> constitutes justification for paying the contractor through the payroll system as an <br /> "employee for withholding purposes." <br /> CERTIFICATIONS: <br /> I hereby certify that the answers to the above questions accurately reflect the anticipated <br /> workin e1 ,►ip for this contract. <br /> . 4 i ,---imeizez.... ,;,...,,z_ <br /> Contractor S. nature Agency/Department Head/Designee <br /> Signature <br /> L2 ,11 F( 5-04://1/6-/y O-P Me412/LikAl 1471 re 4 L-"7 <br /> Printed Name Printed Name 6/V/* <br /> .07//.2 Date Date <br /> Approved As. To Font: <br /> — ti&—.1.......--- Page 2 of 2 <br />