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Income taxes and local head taxes incurred pursuant to this Contract Vendor shall (a) provide <br />and keep in force worker's compensation and unemployment compensation insurance in the <br />amounts required by law, (b) provide proof thereof when requested by the State, and (c) be <br />solely responsible for its acts and those of its employees and agents. <br />3. FORMER STATE EMPLOYEES <br />Contractor certifies that within the six months prior to the execution of this contract s/he has not been <br />employed by a state agency, nor has any employee of the contractor been employed by a state agency where <br />such employment was directly involved with matters that are within the scope of this contract. Pursuant to <br />2418-206 C.R.S., a person who knowingly violates this condition or any other condition specified in Article 18, <br />Part H C.R.S. commits a class 1 misdemeanor (18-1-501 C.R.S.). <br />4. INDEPENDENT CONTRACTOR INFORMATION <br />S. ENTITY TYPE <br />Yes No <br />A. Are you a sole proprietor or individual? / <br />B. Are you a one-person corporation or LLC? <br />C. If neither A or B what type of entity areyou? <br />6. ENTIRE AGREEMENT <br />These provisions together with the attached Purchase Order or Contract, and any referenced attachments, <br />constitute the entire agreement between the parties, and supersede all prior proposals, agreements or other <br />communications between the parties. <br />VENDOR <br />Vendor's Business Name <br />BY: Name of Authorized <br />Title: Official Title of Authorized Individual <br />Date: 11-1,r-12— <br />*Persons signing for the vendor hereby swear and affirm that they are <br />authorized to act on Vendor behalf and admowriedge that the state is <br />retying on their representations to that effect. <br />STATE OF COLORADO <br />John W. Hickenboper, GOVERNOR <br />DEPARTMENT OF NATURAL RESOURCES <br />Date: <br />2 <br />King, Executive Director <br />and Title of person signing for DNR <br />Yes <br />No <br />A. Are you registered with the Secretary of State's Office and/or the IRS to <br />conduct business as an independent contractor? <br />a. If Yes Colorado Secretary of State or <br />b. Internal Revenue Service <br />B. Do you offer services to the general public and have other clients? <br />C. Do you hire retired state em to ees to perform the work? <br />Please Iain all "Yes" answers to Questions B and C: <br />S. ENTITY TYPE <br />Yes No <br />A. Are you a sole proprietor or individual? / <br />B. Are you a one-person corporation or LLC? <br />C. If neither A or B what type of entity areyou? <br />6. ENTIRE AGREEMENT <br />These provisions together with the attached Purchase Order or Contract, and any referenced attachments, <br />constitute the entire agreement between the parties, and supersede all prior proposals, agreements or other <br />communications between the parties. <br />VENDOR <br />Vendor's Business Name <br />BY: Name of Authorized <br />Title: Official Title of Authorized Individual <br />Date: 11-1,r-12— <br />*Persons signing for the vendor hereby swear and affirm that they are <br />authorized to act on Vendor behalf and admowriedge that the state is <br />retying on their representations to that effect. <br />STATE OF COLORADO <br />John W. Hickenboper, GOVERNOR <br />DEPARTMENT OF NATURAL RESOURCES <br />Date: <br />2 <br />King, Executive Director <br />and Title of person signing for DNR <br />