Independent Contractor (IC) Instructions
Revised 2/06/2014
Complete and return the following forms to the Project Director:
Prior to the start of work:
 Complete Independent Contractor Agreement form, page 1
 Sign Independent Contractor Agreement, page 2
 Complete and sign Payee Data Record form, page 7
Upon completion of work:
 Submit invoice for payment (based on payment terms in agreement)
Invoices for payment must include:
o Independent Contractor (IC) Agreement number
o Name and address
o EI# or last 4 digits of SS# of contractor
o Service(s) rendered
o Dates of service(s)
o Amount due
o Itemized original receipts for reimbursement of travel if specified in the Agreement
Additional Information for Independent Contractor:
 Additional funds may be withheld for non-California residents (see Terms and Conditions #19 and 20)
 Any modification to the agreement (i.e., extending dates of service or increasing the dollar amount)
requires prior approval and a formal amendment
 A fully executed agreement will be returned after Foundation approval.
INDEPENDENT CONTRACTOR AGREEMENT
CSU, CHICO RESEARCH FOUNDATION
California State University, Chico
Project #
IC Agreement #
All information below to be completed by IC
Agreement is hereby made between the Independent Contractor (IC) and the CSU, Chico Research Foundation,
(CLIENT) according to the following terms, conditions, and provisions including any attachments which are
incorporated and made a part of this agreement:
IDENTITY OF INDEPENDENT CONTRACTOR
Relevant Business Identification:
Business Name:
Type of Entity
Sole Proprietorship
Partnership
Corporation
Business Address (Street):
(Not P O Box)
Mailing Address if Different:
Business Phone #: (
)
-
Fax #: (
)
-
Email:
Employer Identification #:
Business License #:
City:
Exp. Date:
Relevant Personal Information if different from above:
Name:
SSN (enter last 4 digits)
Home Address (Street):
(Not P O Box)
Mailing Address if Different:
Home Telephone #:
(
)
-
Email:
WORK HISTORY
Please list the last three clients (other than the CSU, Chico Foundations) for whom IC has provided service as an
Independent Contractor:
Date:
Date:
Date:
How many times in the last 12 months have you worked as an Independent Contractor for the
University Foundation or the CSU, Chico Research Foundation?
Where are you currently employed?
CLIENT IDENTITY
Name:
The CSU, Chico Research Foundation
Address:
California State University, Chico, Chico, CA 95929
Business Telephone Numbers:
Sponsored Programs:
Foundation Administration:
(530) 898-5700
(530) 898-6811
Fax:
Fax:
1
(530) 898-6804
(530) 898-6021
To be completed by Project Director prior to sending to IC
WORK TO BE PERFORMED-CLIENT desires that IC perform, and IC agrees to perform, the following work:
SERVICE SPECIFICATIONS
Date work is to begin
mm
dd
and be completed
yy
-
-
mm
dd
yy
Place work is to be performed:
IC will furnish all personnel, equipment, tools, materials and supplies, except as follows:
Other specifications:
TERMS OF PAYMENT-Payment will be by the job or day (not hourly) and CLIENT shall pay IC at the satisfactory
completion of service, or according to the following terms and schedule:
The contract amount shall not exceed $
plus
Prior to payment, IC shall submit a valid invoice containing name, address, EI# or last 4 digits of SS#, IC Agreement # and
amount of payment. Travel expenses included on the invoice must be substantiated with original, itemized receipts attached to the
invoice. The Project Director will certify that services have been performed in accordance with this agreement. The final invoice
will be so marked. Payment is not earned until work is completed in full and satisfactory manner.
By signing below, I am agreeing to the Terms and Conditions, which are incorporated as part of this agreement, and certifying
that the fee proposed is not in excess of my customary charges for similar services.
IC:
Printed Name of IC
Signature of IC
Date (prior to start of work
By signing below, I certify that the contract services are necessary and cannot be performed by anyone currently employed by the
project. In the case of a Sponsored Project, I further certify that the use of an independent contractor and the proposed rate of
compensation have been approved, as required, by the sponsoring agency in writing. I also certify that the fee proposed for the IC
is customary and competitive for such services.
PD:
Printed Name of Project Director
Signature of Project Director
Date (prior to start of work)
CLIENT: THE CSU, CHICO RESEARCH FOUNDATION
Signature of Authorized Research Foundation Representative
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Date
a court of competent jurisdiction. The product or result
developed by the IC pursuant to this agreement is the
property of the CLIENT and shall not be used by the IC
without the CLIENT's written authorization.
STANDARD TERMS AND CONDITIONS
1.
2.
3.
4.
COMMENCEMENT OF WORK
Work shall not commence until IC has received a fully
executed agreement and IC has been given approval to
proceed. Any work performed by IC prior to the date of
approval shall be considered as having been performed
at IC’s own risk and as a volunteer.
INDEPENDENCE OF IC
IC understands IC is not the CLIENT's employee and is
not entitled to any benefits provided by CLIENT to its
employees. IC will perform all services in an
independent capacity, subject to the CLIENT's direction
and control only as to the result and not the manner or
means of accomplishing that result. Except as specified
above, IC shall, at IC's sole expense provide the facilities
where work is to be performed, all instrumentalities or
supplies, any required licenses or permits, and the costs
of additional helpers or subcontractors, travel, and any
other expense incurred by IC.
NOTICE TO IC REGARDING TAX LIABILITY
IC understands that IC is responsible to pay, according
to law, IC's income taxes and, if required, selfemployment (social security) taxes. No income or
payroll taxes shall be withheld or paid by CLIENT on
behalf of IC or employees of IC.
INSURANCE RESPONSIBILITY OF IC
IC assumes all risks as an independent contractor, and
agrees to obtain all insurance necessary for IC's
protection in connection with work under this
agreement and as required by law, including workers’
compensation insurance. IC agrees to indemnify,
defend, and hold harmless the CLIENT and its officers,
employees and agents from any injuries, property
damage, or other claims and losses resulting from the
activities of the IC or the IC’s employees, agents or
subcontractor in performance of this agreement,
including any losses or claims made by IC’s employees
or agents. In addition, IC agrees to pay attorney’s fees
and other legal expenses. CLIENT shall not provide
worker’s compensation insurance. IC shall comply with
workers' compensation insurance laws with respect to
IC and IC's employees.
5.
NON-DISCRIMINATION
IC agrees to abide by all appropriate state and federal
laws and regulations prohibiting discrimination against
any person on the basis of religion, color, ethnic group,
sex, age, physical or mental disability, or any other
prohibited basis in connection with the business
performed under this contract.
6.
OWNERSHIP OF RESULTS
Contractor agrees that material produced by Contractor
under this agreement shall be “work for hire’’ and shall
be owned by Client. IC shall not utilize any
information, unless a matter of public record, which is
received by him by reason of this agreement without
CLIENT’s prior written agreement unless so ordered by
7.
TERMINATION WITHOUT CAUSEEither party may terminate this agreement without
cause after giving 15 days written notice to the other by
regular mail to the respective addresses on the first page
of this agreement. The parties shall deal with each
other in good faith during the 15-day period after notice
is given.
8.
TERMINATION WITH CAUSE
With reasonable cause, either party may terminate this
agreement effective immediately upon giving written
notice of termination for cause. Reasonable cause shall
include material violation of this agreement and any act
exposing the other party to liability for personal injury
or property damage. The failure of either party to
exercise any of its rights under this agreement for a
breach thereof shall not be deemed to be a waiver of
such rights or a waiver of any subsequent breach.
9.
CHOICE OF LAW
Any dispute related to this agreement shall be decided
in accordance with the laws of the State of California.
Further, Contractor shall comply with any State or
Federal regulation applicable to Contractor’s
performance under this agreement.
10. NO AUTHORITY TO BIND CLIENT OR TO
ASSIGN
IC has no authority to enter into agreements on behalf
of CLIENT. IC is not authorized to act for the CLIENT
in any way. This agreement is not assignable by the IC
without written consent of CLIENT.
11. TERMS OF THIS AGREEMENT
This is the entire agreement of the parties and cannot be
modified orally. If any part of this agreement shall be
held unenforceable, the rest of this agreement will
nevertheless remain in force. This agreement may be
supplemented or amended only in writing by agreement
of authorized representatives of the parties. No oral
understanding or agreement not incorporated herein
shall be binding on any of the parties.
12. CONFLICT OF INTEREST
IC must provide full disclosure of any financial interest
that may foreseeably allow IC to materially benefit
from recommendations or agreements made in
connection with the provision of services or products in
connections with this agreement. A Statement of
Economic Interests (Form 700) is required of any IC
who participates or is involved in decisions, which may
foreseeably have a material effect on any CSU or
Foundation financial interest. Form 700 may be
obtained in Kendall Hall, Room 222 or by calling (530)
898-6435.
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the two arbitrators fail to select a third arbitrator
within ten days after their appointment, on
application by either party the additional
arbitrator shall be promptly appointed by the
presiding judge of the Superior Count of the
State of California in and for the County of
Butte, acting as an individual. The party making
the application shall give the other party ten days
notice of the application.
The arbitration shall be conducted under California Code
of Civil Procedures sections 1280, et seq. Hearings shall
be held in Butte County, California. All notices,
including notices under Code of Civil Procedure section
1290.4, shall be given in writing either by personal
service or by registered or certified mail, postage prepaid,
and return receipt requested, or by facsimile transmission
with a confirmation copy delivered by mail. Notice shall
be considered given three days after mailing. Notices
shall be addressed as shown in this document, except that,
if any party gives notice of a change of name or address,
notices to that party shall thereafter be given as shown in
that notice.
13. NON-PERFORMANCE BY CONTRACTOR
CLIENT may terminate the agreement and be relieved of
the payment of any consideration to IC should IC fail to
perform the covenants contained herein at the time and
in the manner provided. In the event of such termination,
Client may proceed with the work in any manner
deemed proper by Client. The cost to Client shall be
deducted from any sum due IC under the agreement and
the balance, if any, shall be paid IC upon demand.
14. ENDORSEMENT
Nothing contained in this agreement shall be construed
as conferring on any party any right to use the other
party’s name as an endorsement of product or service,
or to advertise, promote or otherwise market any
product or service without the prior written consent of
the other parties. Furthermore nothing in this agreement
shall be construed as an endorsement of any
commercial product or service provided to Client, its
officers or employees.
15. COMPLIANCE WITH NLRB ORDERS
In submitting a bid or signing a contract IC swears
under penalty of perjury that no more than one final,
unappealable finding of contempt of court by a federal
court has been issued against IC within the immediately
preceding two-year period because of IC’s failure to
comply with an order of a federal court which orders IC
to comply with an order of the National Labor
Relations Board.
18. WARRANTY:
IC warrants any material produced by IC under this
agreement shall be original except for such portions
from copyrighted works as may be included with
permission of the copyright owners, shall contain no
libelous or unlawful statements or materials, and shall
not infringe upon any copyright, trademark, patent, or
statutory or other proprietary rights of others. IC shall
hold harmless Foundation from any costs, expenses and
damages resulting from any breach of this warranty.
16. EXAMINATION AND AUDIT
IC warrants that IC maintains records in accordance
with standard accounting practices and that such
records shall be maintained for at least four years
following receipt of final payment under this
agreement. Further, IC shall allow Client and/or
representatives of the State of California or Federal
Government access to such records for examination and
audit at times mutually convenient to the parties. Cost
disallowances shall result in IC’s repayment of
disallowed costs to Client within 30 days of Client’s
notification to IC. Delays beyond 30 days that require
Client to seek legal assistance or to incur other
expenses related to collecting the disallowed costs, or
having to repay the disallowed costs, shall be
reimbursed to Client by IC.
19. PAYMENT WITHHOLDING:
As required by law, CLIENT will withhold 7% for nonCalifornia residents for California State income tax
unless a copy of the waiver or reduction in withholding
issued by the California State Franchise Tax Board is
attached to the invoice. For non-U.S. citizens, CLIENT
may be required by law to withhold 30% for federal
income tax and 7% for state income tax. Contact
CLIENT for forms that may lower the withholding
amounts.
20. NONRESIDENT WITHHOLDING WAIVER
REQUEST:
Non-California residents may request that income taxes
be withheld at a lower rate or waived by sending a
completed form FTB 588 or 589 to the Franchise Tax
Board at least 21 days in advance of performing
services under this agreement. A waiver will generally
be granted when a payee has a history of filing
California returns and making timely estimated
payments. If the IC will be performing work outside of
California or partially outside of California, a waiver or
reduced withholding rate may be granted. Form FTB
588 or FTB 589 may be obtained by contacting the
Franchise Tax Board at 800.852.5711 or 916.845.6500
17. ARBITRATION
IC agrees that any controversy arising from this
agreement or its breach shall be resolved by three
arbitrators appointed as set forth below:
a. Within ten days after notice by either party to the
other requesting arbitration and stating the basis
of the claim, each party shall appoint one
arbitrator. Notice of the appointment shall be
given by each party to the other when made.
b. The two arbitrators shall promptly choose a third
arbitrator to act with them. If a party fails to
select an arbitrator within the time allowed, or if
FEDERAL TERMS AND CONDITIONS
4
(In addition to Standard Terms & Conditions)
Besides any OBM circulars (e.g. A-21, A-110, and A-133) that may apply to subawardee, subawardee agrees to
abide by the following terms and conditions in the conduct of this federally funded agreement, as appropriate
and applicable:
A. Equal Employment Opportunity provisions of E.O. 11246, E.O. 11375, and 41 CFR part 60
B. Copeland Anti-Kickback Act (18 U.S.C. 874 and 40 U.S.C. 276c)
C. Davis-Bacon Act as amended (40 U.S.C. 276a-a7)
D. Clean Air Act 940 U.S.C. 7401 et seq) and the Water Pollution Control Act (33 U.S.C. 1251 et seq)
E. 48 CFR part 31, Contract Principles and Procedures or uniform cost accounting standards
F. 43 CFR Part 18 New restrictions on lobbying
G. 43 CFR Part 12, Subpart E Buy American requirements for assistance programs
H. 43 CFR Part 12, Subpart E Governmentwide debarment and Suspension and Governmentwide
requirements for Drug Free Workplace
6
PAYEE DATA RECORD
(REV 11-2008)
Required in lieu of IRS W-9 Form and State of California Form 590 when conducting
business with the CSU, Chico Research Foundation or University Foundation.
PLEASE
RETURN
TO:
CSU, Chico Research Foundation
C/O AS Business Office
California State University, Chico
Chico, CA 95929-0248
University Foundation
C/O AS Business Office
California State University, Chico
Chico, CA 95929-0248
530-898-6815 (Voice) 530-898-6999 (Fax)
PHONE NUMBER
PAYEE BUSINESS NAME
Section I
PAYEE
(
)
INDIVIDUAL - ENTER PAYEE'S/OWNER’S FULL NAME (Last, First, M.I.)
Last
First
M.I.
PURPOSE:
Information contained in this form will
be used to prepare information
returns (Form1099) and for
withholding on payments to
nonresident payees. Prompt return of
this fully completed form will prevent
delays when processing payments.
MAILING ADDRESS (Number and Street or P.O. Box Number)
(See Privacy Statement on next
page)
(REQUIRED)
(City, State and Zip Code)
CHECK ONE BOX ONLY IN THIS SECTION
Section II
PAYEE
ENTITY
AND
TAX
I.D.
NUMBER
(TIN)
IF YOU USE YOUR SOCIAL SECURITY/ITIN NUMBER TO FILE YOUR INDIVIDUAL/BUSINESS TAXES
SOCIAL SECURITY NUMBER/ITIN
-
NOTES:
Governmental entities, federal, state,
and local (including school districts)
and Foundation Employees are not
required to submit this form.
IF YOU USE A BUSINESS TAX ID NUMBER TO FILE YOUR BUSINESS TAXES
Payment will not be processed
without an accompanying taxpayer
I.D. number
(Attorney/Law Firm)
(REQUIRED)
ALL OTHER CORPORATIONS
FEDERAL EMPLOYERS IDENTIFICATION NUMBER (TIN)
IS THE PAYEE OR THE BENEFICIARY OF THE PAYMENT A U.S.CITIZEN OR
PERMANENT RESIDENT ALIEN? (APPLIES TO ALL PAYEES)
MANDATORY RESPONSE
Section III
Yes
PAYEE
RESIDENCY
DECLARATION
All Payments
Made By the
Foundations Are
Subject to Federal
and California
State Tax Laws
No (If No, you must contact Accounts Payable at (530)898-6811 for further information)
CALIFORNIA STATE TAX WITHHOLDING STATUS (APPLIES TO ALL PAYEES)
- Qualified to do business in CA or a permanent place of business in CA
Nonresident (See Reverse) Payments to non residents for services may be subject to state withholding
WITHHOLDING FROM FRANCHISE TAX BOARD ATTACHED
FEDERAL INCOME TAX WITHHOLDING STATUS (APPLIES TO INDIVIDUALS ONLY):
Not a U.S. Citizen and I Do Not Have a Permanent Resident Green Card
(REQUIRED)
Note: All Foreign Citizens/Entities must complete a tax analysis before payments can be made.
Notes:
a. An estate is a resident if decedent
was a California resident at time of
death.
b. A trust is a resident if at least one
trust is a California resident.
c. Rules for assessing State taxes
differ significantly from Federal tax
rules. (Please see next page)
NOTE:
Prior to making payment to foreign
citizens, United States tax laws
require all employers to perform a tax
analysis with respect to country of
citizenship to determine residency for
Federal tax purposes.
(Please see next page)
Under penalties of perjury, I hereby certify that:
Section IV
CERTIFYING
SIGNATURE
(REQUIRED)
1. All information provided on this document is true and correct. If my residency status should change, I will promptly notify you.
2. The number shown on this form is my correct taxpayer identification number (or I am writing for a number to be issued to me),
3. I am not subject to backup withholding because : (a) I am exempt from backup withholding, or (b) I have not been notified by the
Internal Revenue Service (IRS) that I am subject to backup withholding as a result of failure to report all interest and dividends, or (c)
the IRS has notified me that I am no longer subject to backup withholding, AND
4. I am a U.S. person (including a U.S. resident alien).
AUTHORIZED PAYEE REPRESENTATIVE’S NAME (Type or Print)
TITLE
SIGNATURE
DATE
7
PHONE NUMBER
CSU, Chico Research Foundation or University Foundation
FOREIGN CITIZENS and FOREIGN BUSINESSES
Federal tax withholding regulations differ significantly from California tax
withholding requirements. A tax analysis consultation and additional forms
must be completed before a payment can be released.
PAYEE DATA RECORD (REV 1-2004)
ARE YOU A RESIDENT OR NONRESIDENT?
Each corporation, individual/sole proprietor, partnership, estate or
trust doing business with the CSU, Chico Research Foundation or
University Foundation must indicate their residency status along
with their taxpayer identification number.
ARE YOU SUBJECT TO NONRESIDENT WITHHOLDING?
Payments made to California nonresident payees, including
corporations, individuals, partnerships, estates and trusts, are
subject to withholding. California nonresident payees performing
services in California or receiving rent, lease or royalty payments
from property (real or personal) located in California will have
7% of their total payments withheld for state income taxes.
However, no withholding is required if total payments to the
payee are $1500 or less for the calendar year.
A corporation will be considered a "resident" of California if it
has a permanent place of business in California. The corporation
has a permanent place of business in California if it is organized
and existing under the laws of this state or, if a foreign corporation
has qualified to transact intrastate business. A corporation that has
not qualified to transact intrastate business (e.g., a corporation
engaged exclusively in interstate commerce) will be considered as
having a permanent place of business in this state only if it
maintains a permanent office in this state that is permanently
staffed by its employees.
A California nonresident payee may request that income taxes be
withheld at a lower rate or waived by sending a completed form
FTB 588 to the address below. A waiver will generally be granted
when a payee has a history of filing California returns and making
timely estimated payments. If the payee activity is carried on
outside of California or partially outside of California, a waiver or
reduced withholding rate may be granted. For more information,
contact:
For individuals/sole proprietors, the term "resident" of
California includes every individual who is in California for other
than a temporary or transitory purpose and any individual
domiciled in California who is absent for a temporary or transitory
purpose. Generally, an individual who comes to California for a
purpose, which will extend over a long or indefinite period, will
be considered a resident. However, an individual who comes to
perform a particular contract of short duration will be considered
a California nonresident.
Franchise Tax Board
Nonresident Withholding Section
Attention: State Agency Withholding Coordinator
P.O. Box 651 Sacramento, CA 95812-0651
Telephone: (916) 845-4900
FAX: (916) 845-4831
For withholding purposes, a partnership is considered a
California resident partnership if it has a permanent place of
business in California. An estate is considered a California estate
if the decedent was a California resident at the time of death and
a trust is considered a California trust if at least one trustee is a
California resident.
If a reduced rate of withholding or waiver has been
authorized by the Franchise Tax Board, attach a copy to this
form.
Section V – W-9 Certification
You must cross out item 2 on the certification if you have been
notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and
dividends on your tax return. For real estate transactions, item
1 does not apply. For mortgage interest paid, acquisition, or
abandonment of secured property, cancellation of debt,
contributions to an individual retirement arrangement (IRA),
and generally, payments other than interest and dividends you
are not required to sign the Certification, but you must provide
your correct TIN. For further instructions and information
please refer to IRS Form W-9.
PRIVACY STATEMENT
More information on California residency status can be obtained
by calling the Franchise Tax Board at the numbers listed below:
From within the United States, cal1 1-800-852-5711
From outside the United States, cal1 1-916-845-6500
For hearing impaired with TDD, call 1-800-822-6268
Website - www.ftb.ca.gov
Section 7(b) of the Privacy Act of 1974 (Public Law 93-5791) requires that any federal, state, or local governmental agency which requests an individual to disclose his social security account number
shall inform that individual whether that disclosure is mandatory or voluntary, by which statutory or other authority such number is solicited, and what uses will be made of it.
The State of California requires that all parties entering into business transactions that may lead to payment(s) from the State must provide their Taxpayer Identification Number (TIN) as required by
the State Revenue and Taxation Code, Section 18646 to facilitate tax compliance enforcement activities and to facilitate the preparation of Form 1099 and other information returns as required by the
Internal Revenue Code, Section 6109(a). The TIN for individual and sole proprietorships is the Social Security Number (SSN).
It is mandatory to furnish the information requested. Federal law requires that payments for which the requested information is not provided be subject to a 31% withholding and state law imposes
noncompliance penalties of up to $20,000.
You have the right to access records containing your personal information, such as your SSN. To exercise that right, please contact the business services unit or the accounts payable unit of the state
agency (ies) with which you transact that business.
Please call the Department of Finance, Fiscal Systems and Consulting Unit at (916) 324-0385 if you have any questions regarding this Privacy Statement. Questions related to residency or
withholding should be referred to the telephone numbers listed above; all other questions should be referred to the requesting agency listed in Section
8