C153316 PIF Contract

• Contract/PO #: C153316
• Contractor Name: Winter Park Water and Sanitation District
• Contract Type: Loan
• Water District: 0
• County: Grand
• Bill Number: SB 77-35
• Loan Projects - Doc Type: Contract Documents

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(�I ;li•I'11�1� nrJr;�,
TO Rudolph Livirnlstc,n
Executive Diret:LOr
Departmerit of Rer .onnel
Ile State Centennial bzlilding
1313 Sherman Street
Denver, Colorado 80203
RE: Personal Service Contract_Classi.`:
The undersigned hereby certifies that the attach, -,l contract, Contract Routing
No. e frcm the __D-eDartmeat-.Qf. Natv. has b, n
exanined, and the following have Deen the curr[.-t classi-
fication of the contractor undertaking the services dad wo-k which are the subject
of the contract. Tl:e contractor is a firm or individi_i-l.:
(a) who is responsible for the of to be undertaken,
but is not subject to the State,' control a,3 to the means and
methods of accomplishing these results;
YEs NO
(b) who select:: his clients and is' flee to rr�rk for ono of more
during any given interval;
YES _ f O
(c) who determzines the time and place the work will be performed;
YES td0
(d) who providrzs the tools, material; and office space necededl to
perform tilt'` tiY�rkt
YES NO
T (e) who does not participate directly or indirectly in benefit
programs of the State (for example, it not covered by thy: state
for Workmen's Compensation insuring for injury to himself, for
Public Liability insuring for injury to others, or for
unemployrnment compensation) ;
-}{ - _ -- YES N O
(f) who may agree to perform spec i : i,. servi co :; for eci price and
generally does not receive regular amounts at� intervals.
e„ O
Affirmative responses to the listr.d cla ;sif ica in a, i ttify the
services to be contracted as those of an indep,ancle.nt cent a egative
responses as those of an (temporary) employee. RnV n' t1 'Wrer' cnsa where the:
h n
certified classification is that of an independent c._ ct will require, in
addition, a qualification by wri' -"c-n cxlltinuti,)u n° "�i ing this certification.
If the. explanation is not attsc�e�c t-, c:ia ST cat I shall be presumed to be
that of an employee.
Accordingly, tLc attached contact 1, deteimiu,•d to bra And 11 sn certified
as an independent contractor /tX XMXxyxxNX. (_?trike oar,) contract.
Upon examination of the records of this Delmirtrncnt an(i inquiry of th'2 con-
tractor, the following is the history of any and .)11 contr;:cts e.ntcr,_t1 into
between thr: contractor and the State during the la:.t two years:
Cla ,c:ification
Executive Dr ]Rri Cnt_ Bt:c ;inr.ia. Date 7in (I i n,i D,atct of Contract
NONE
SIGNLm this day of _ _ � 19---.
STIM-: OF COLORADO
DEPAFtTru:NT or__ATU AL JE_ O ELLS --
Ey"-- -- - ---�— -- - - -- —
(Title)