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<br />. <br /> <br />. <br /> <br />Independent Contractor certification <br /> <br />The contractor is a firm or individual which: <br /> <br />1. is responsible for the results of the work to be undertaken, <br />but is not subject to the state's control as to the means and <br />methods of accomplishing these results; <br /> <br />x <br /> <br />Yes <br /> <br />No <br /> <br />2. selects his clients and is free to work for one or more during <br />any given interval; <br /> <br />x <br /> <br />Yes <br /> <br />No <br /> <br />3. determines the time and place the work will be performed; <br /> <br />x <br /> <br />Yes <br /> <br />No <br /> <br />4. provides the tools, materials and office space needed to <br />perform the work; <br /> <br />x <br /> <br />Yes <br /> <br />No <br /> <br />5. agrees to perform specific services for a fixed price and does <br />not receive regular payments at stated intervals. <br /> <br />x <br /> <br />Yes <br /> <br />No <br /> <br />6. If the contractor is an individual, has he or she previously <br />been an employee of the state? <br /> <br />Yes <br /> <br />x <br /> <br />No <br /> <br />If yes, give last date of employment. <br /> <br />- NA - <br /> <br />Aff irmati ve responses to <br />relationship is that of <br />neqative response submit a <br /> <br />items 1 through 5 indicate <br />an independent contractor. <br />written explanation. <br /> <br />that <br />For <br /> <br />the <br />any <br /> <br />2 <br />