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<br />.. <br /> <br />CERTIFICATION <br /> <br />.. <br /> <br />TO: Rudolph Livingston <br />Executive Director <br />Department of Personnel <br />lIB State Centennial Building <br />1]13 Sherman Street <br />Denver, Colorado 80203 <br /> <br />HE: Personal Service Contract Classification <br /> <br />The undersigned hereby certifies that the attached contract, Contract Routing <br />No. , from the Department of Natu~al ResC:Jl1rC'Ps (Dept.) has been <br />examined, and the following have been determlne concerOlng the correct classi- <br />fication of the contractor undertaking the services and work which are the subject <br />of the contract. The contractor is a firm or individuol: <br /> <br />(a) who 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- YES <br /> <br />NO <br /> <br />(b) who selects his clients and is free to work for one or more <br />during any given interval; <br /> <br />-X- YES <br /> <br />NO <br /> <br />(c) who determines the time and place the work will be performed; <br /> <br />-X.- YES <br /> <br />NO <br /> <br />(d) who provides t.he tools, materials and office space needed to <br />perform the work; <br /> <br />-X- YES <br /> <br />NO <br /> <br />(e) who does not participate directly or indirectly in benefit <br />programs of the State (for example, is not covered by the State <br />for Workmen's Compensation insuring for injury to himself, for <br />Public Liability insuring for injury to others, or for <br />unemployment compensation); <br /> <br />-X- YES <br /> <br />NO <br /> <br />(f) who may agree to perform specific services for a fixed price and <br />generally does not receive regular amounts at stated intervals. <br /> <br />-X- YES <br /> <br />NO <br /> <br />Affirmative responses to the listed classification indicia identify the <br />services to be contracted as those of an independent contractor; negative <br />responses as those of an (temporary) employee. Any negative response where the <br />certified classification is that of an independent contractor will require, in <br />addition, a qualification by written explanation accompanying this certification. <br />If the explanation is not attached, the classlflcation shall be presumed to be <br />that of an employee. <br /> <br />Accordingly, the attached contract is determined to be and is so certified <br />as an independent contractor~~x~~~ (strike ~) contract. <br /> <br />Executive Department <br /> <br />of the records of this Department and inquiry of the con- <br />is the history of any and all contracts entered into <br />and the State during the last t.....'o years: <br />Classification <br />Beginning Date Endinq Date of Contract <br /> <br />Upon examination <br />tractor, the following <br />between the contractor <br /> <br />NONE <br /> <br />SIGNED this <br /> <br />day of <br /> <br />. 19 <br /> <br />Executlve Dlrector <br />(Title) <br />