PROJ00405

• Contract/PO #: C153304
• Contractor Name: Beaver Park Water, Inc.
• Water District: 0
• County: Fremont
• Bill Number: XB 99-999
• Loan Projects - Doc Type: Contract Documents

CERTIFICATION

TO: Rudolph Livingston
Executive Director
Department of Personnel
118 State Centennial Building
1313 Sherm~n Street
Denver, Colorado 80203

RE: Personal Service Contract Classification

The undersigned hereby certifies that the attached contract, Contract Routing
No. . from the Department of Na~u~a] HesQllrres (Dept.) has been
examined, and the following have been determ~ne concernIng the correct classi-
fication of the contractor undertaking the services and work which are the subject
of the contract. The contractor is a firm or individual:

(a) who is responsible for the results of the work to be undertaken,
but is not subject to the State's control as to the means and
methods of accomplishing these results;,

...JL... YE S

NO

(b) who selects his clients and is free to work for one or more
during any given interval;

_2L- YES

NO

(e) who determines the time and place the work will be perfOI:llled;

_x_ YE S

NO

(d) who pI"ovidcs t.he tools, materials and office space necd(~d to
perform the work;

-X- YES

NO

(e) who does not participate directly or indirectly in benefit
programs of the State (for example, is not covered by the State
for Workmen's Compensation insuring for injury to himself, for
Public Liability insuring for injury to others, or for
unemployment compensation);

_-X- YES

NO

(f) who may agree to perform specific services for a fixed price and
generally does not receive regular amounts at stated intervals.

~YES

NO

Affirmative responses to the listed classification indicia identify the
services to be contracted as those of an independent contractor; negative
responses as those of an (temporary) employee. Any negative response where the
certified classification is that of an independent cOntractor will require, in
addition, a qualification by writte~ explanation accompanying this certification.
If the explanation is not attached, the classl.fl.cation shall be presumed to be
that of an employee.

Accordingly, the attached contract is determined to be and is so certified
as an independent conttactorlJt~x~~~ (strike ~) contract.

Executive Department

of the records of this Department and inquiry of the COI1-
is the history of any and all contracts entered into
and the State during the last two years:
Classi f ication
Beginning Date Endinq Date of Contract

Upon examination
tractor, the following
between the contractor

NONE

SIGNED this

day of

. 19

STATE OF COLORADO
DEPARTMENT OF NATURAL RESOURCES

By
_Exe~utlve Dlrector
('htle)