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I VillI V-MI.,,-UL.-I CERTIFICATION . , - . ~. TO: Rudolph Livingston Executive Director Department of Personnel 118 State Centennial Building 1313 Sherman Street Denver, COlorado 80203 BE: Personal Service Contract Classification The undersigned hereby certifies that the attached contract, Contract Routing No. , f~om the Department of Natural Resources (Dept.) has been examined, and the following have been determined concernlng the correct classi- fication of the contractor undertaking the services and work which a~e 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; --lL YES NO " (b) who selects his clients and is free to work for one or mOre during any given interval; -1L YES NO (c) who ~etermines the time and place the work will be perfo~edl X YES NO (d) who provides the tools, materi~ls and office space needed to perform the work; x YES NO (e) who does not participate directly or indirectly in benefit prog~ams of the State (for eX~ple, is not covered by the State for Workmen's Compensation ins~ring for injury to himself, for Public Liability insuring for injury to others, or for unemployment compensation); , ,"' x YES NO (f) who ~ay agree to perform specific services for a fixed price and generally does not receive reg~lar amounts at stated intervals. -2L- 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 Qt~~~ empl~yee. Any necrative response where the certified classification is that of an inQependent contractor will require, in addition, a qualification by written exp14nation accompanying this certification. If the explanation is not attached, the c~ass~f~cation shall be presureed to be that of an e~ployee. Accordingly, the attached contract is determined to be and is so certified as an independent contractor/temporary em~loyee (strike~) contract. Executive Departmant NONE of the records of this Department and inquiry of the con- is the history of ~ny and all contracts entered into and the State duri~g the last two years: Classification Beqinning Date Endina Date of Contract Upon examination tractor, the fallowing hetween the contractor SIGNED this J'3 .L day of ~ , 19'!l. STATE OF COLORADO ::PA15~r;; RESOURCES : F. '" or (Ti tle)