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<br />THE FOLLOWING TO BE COMPLETED BY HR PERSONNE L ONLY <br /> <br />1. I attest that the acquisition of services from the independent contractor will not result in <br /> <br />the separation or displacement of state personnel system staff. Employees directly <br />affected by the contract will be given proper notices as defined in R ule 10 - 5. <br /> <br />2. Review/Approval Criteria: The following are statutory citations by which the impacts to <br /> <br />state personnel system staff are evaluated. Please identify those statutory criteria that <br />would make this request an approvable agreement. <br /> <br /> <br />The contract meets the relevant cost savings test. A “Cost Analysis” form must be completed and <br />attached to this form. C.R.S. 24 - 50 - 503 <br /> The contracts is for a new state program (created after 4/7/93), which statutorily authorizes the <br />performance of the program by in dependent contracts. C.R.S. 24 - 50 - 504(2)(b) <br /> The contracted services are not available within the state personnel system, or cannot be performed <br />satisfactorily by state employees, or are of a highly specialized or technical nature. C.R.S. 24 - 50 - <br />504(2)( c) <br /> The services are incidental to a contract for the purchase or lease of real or personal property. <br /> C.R.S. 24 - 50 - 504(2)(d) <br /> The contract is needed to protect against a conflict of interest, or to ensure independent and <br /> unbiased findings in cases where there is a clear need for a different, outside perspective. C.R.S. <br /> 24 - 50 - 504(2)(e) <br /> The contractor will provide equipment, materials, facilities, or support services that could not feasibly <br />by provided by the state in the location where the services a re to be performed. C.R.S. 24 - 50 - <br />504(2)(f) <br /> The contractor will conduct training courses for which appropriately qualified state personnel system <br />instructors are not available. C.R.S. 24 - 50 - 504(2)(g) <br /> The services are of an urgent, temporary, or occasi onal nature. C.R.S. 24 - 50 - 504(2)(h) <br /> The contract is for purchased services. (The acquisition of services which directly benefit specific <br />groups or individuals in the public at large.) C.R.S. 24 - 50 - 504(3) <br /> This is an intergovernmental agreement. C.R. S. 24 - 50 - 508 <br /> The services provided are for a term of six months or less and are not expected to recur on a regular <br />basis. C.R.S. 24 - 50 - 513 <br /> <br />PERSONAL SERVICES CERTIFICATION <br />HR Representative ONLY <br /> <br />Independent Contractor Certification: The signature below indicates that the contract or commitment <br />voucher is indeed an independent contract that does not create an employee - employer relationship and <br />that these documents contain the required independent contractor language as part of the Director’s <br />Rules 10 - 4(E )(4). <br /> <br />Department/Institution Certification: I hereby certify that the attached agreement for personal services <br />meets at least one criterion stated above and that all responses on this certification are true and <br />accurate, to the best of my knowledge. <br /> <br />Date : by: <br /> <br /> <br /> Human Resource Representative Title/Work Phone Number <br /> <br />Revised document DPA 11/30/05 <br /> <br /> <br /> 3 <br />