INDEPENDENT CONTRACTOR AGREEMENT (ICA)

SECTION ONE - INSTRUCTIONS FOR USE:

This ICA form may be used to pay or encumber funds for one-time nonrecurring or scheduled payment contracts that are greater than $5000.00, exceed 45 days in length and completion benchmarks have been agreed to and progress payments are to be made to individuals engaged in technical, professional or specialized skills who:

Provide one-time nonrecurring payment grater than $5000.00 Schedule progress payments (no limit). Are being paid greater than $5,000.00 in total, (receipts required for travel

reimbursements), and Are not otherwise employed by the Nevada System of Higher Education (which

includes CCSN, DRI, and GBC, TMCC, UNLV, UNR, WNCC, or any of the NSHE System Administration Offices).

If the payment is $5,000 or less and travel expenses such as lodging or airfare have been prepaid by the University by method of P-Card or Payment Voucher, DO NOT continue processing this form. See instructions for the ISP contract.

SECTION TWO - Before the ICA contract is initiated: A Workers Classification form, W-9 (for U.S. Citizens) or W8BEN (if International), and Insurance requirements, must be submitted to the Accounts Payable department prior to the contract completion. Once the Worker has been classified you will be notified of the classification and whether to proceed with the contact or not. For questions regarding the proper use of this form or to determine ISP or ICA status, contact the Assistant Controller for Accounts Payable at 895-1143.

Nonresident Aliens: If the individual is not a U.S. Citizen or lawful “permanent” resident (green card holder), read the U.S. Tax Information for nonresident aliens information sheet, and contact the Assistant Controller for Accounts Payable at 895-1143 before proceeding with this document, additional documents may be required.

Hiring former NSHE employees: In an IRS audit, agents almost always examine whether an employer wrongly classified employees as independent contractors. See information fact sheet included in this package.

Insurance Requirements: The Contractor shall not commence work before proof of the required insurance is evidenced by a certificate of insurance on an ACCORD 25 form, provided by the Contractor’s insurance agent/broker or a notarized Affidavit of Rejection of Coverage for Workers’ Compensation is received. By endorsement to all general and umbrella or excess liability policies, the “Board of Regents, Nevada System of Higher Education” shall be named as an additional insured for all liability arising from the contract. The Certificate of Insurance must be filed with the contract so that it can be found in the event of a loss. Prior approval of the insurance policies by NSHE shall be a condition precedent to any payment of consideration under the contract.

SECTION THREE - Once you have received approval to proceed with the ICA contract: Complete and submit the ICA contract, a flyer announcing the engagement, invitation letter or complete the exhibits page included in this package. Submit the completed package to the Controller’s Office, Accounts Payable mail stop 1053.

Negotiating the contract: It is recommended that the traveler makes his/her own travel arrangements. When negotiating the contract payment totals, fees, expenses such as lodging, airfare and meal costs should be estimated and be all inclusive of the entire contract amount.

Guidelines to consider: When negotiating the contract, determine if the payment will consist of a fee as well as travel expenses; remember the total of the contract.

If meals and lodging are included in your contract negotiation, the daily allowance is $45.00; (Breakfast $10.00; Lunch $15.00; Dinner $20.00) If any hosted meal is anticipated, the meal allowance for that meal must not be considered in the allowance for that day.

Lodging may not exceed $150.00/night, including any taxes for stay during Sunday – Thursday, and $175.00/night, including taxes for stay during Friday - Saturday. These rates may be exceeded on a case-by-case basis, with proper approval of the President, Provost, Vice President, Dean or Director.

Prepayment methods:

Lodging may be prepaid by P-Card; Lodging may also be prepaid by UNLV by method of a payment voucher accompanied by the hotels confirmation of the reservation.

Rental Vehicles are the responsibility of the contractor and may not be billed to a university contracted agency.

Airfare may be prepaid by method of P-card or the Travel Authorization Form. S:\Accounts Payable\Forms\Travel Authorization Form. PDF

Best Practice Example: Traveler to make own arrangements fee inclusive of travel expenses: Total cost to the department and payable to the traveler = $6000.00 (no receipts required)

Example: Traveler with university prepaid arrangements: $6000.00 fee + $123.50 for five days of meals (no receipts required), less one hosted lunch+ $550.00 for Airfare, prepaid by P-card, + $450.00 for five days of lodging for out of state guest, prepaid by P-card: Total department cost = $7,123.50 + hosted meal. Payable to Traveler = $6123.50

Example: Fee negotiated plus traveler to make own arrangements with travel to be reimbursed after the engagement is complete: $6000.00 fee + $123.50 for five days of meals, less one hosted lunch+ $550.00 for Airfare, prepaid by traveler, + $450.00 for five days of lodging for out of state guest, prepaid by traveler: Total department cost = $7,123.50 + hosted meal. Due to Traveler = $7123.50 with acceptable paid receipts including hotel folio, proof of airfare cost, meal receipts (will be reimbursed at a maximum of $45.00 per day), and any additional expenses.

Scheduled Payments: Payments to ICA will be processed against the encumbered contract when invoiced by the department or contractor. If travel expenses are to be reimbursed, all required receipts must be attached to the payment request form.

Please call 895.1143 for your department’s assigned ISP numbers.

DO NOT SEND INFORMATION PAGES TO THE CONTRACTOR; KEEP IT FOR YOUR REFERENCE. SEND ONLY APPLICABLE PAGES AND FAX SIGNATURES ARE ACCEPTED.

Hiring Independent Contractors who are Former NSHE Employees The purpose of this announcement is to clarify NSHE and UNLV policies and procedures on hiring independent contractors. Individual departments negotiate and draft contracts with independent contractors. Once an independent contractor agreement (ICA) or an Independent Service Provider contract (ISP) form is completed, it is submitted to the Accounts Payable Department for review and approval. Hiring departments are required to provide complete information and forms, including additional supporting documents on independent contractors and guest speakers who are not U.S. citizens or legal permanent residents. If it is concluded that the individual does not qualify as an independent contractor, the independent contractor agreement is returned to the initiating department with a notification. Payments cannot be processed based on incomplete or improper forms. The University strictly adheres to the IRS guidelines and "common law" tests in determining whether a service provider qualifies as an independent contractor or as a University employee. The determination criteria are provided in the Accounts Payable web page, http://www.unlv.edu/accounts payable/html. To ensure our conformity with NSHE policy and the federal regulations, individuals should be hired as LOA’s when one of the following conditions is met:

1. The individual is currently maintaining a position with NSHE, which is comprised of the Community College of Southern Nevada, Desert Research Institute, Great Basin College, Nevada State College at Henderson, Truckee Meadows Community College, UNLV, UNR, Western Nevada Community College, or NSHE System Administration Offices. 2. The individual formerly maintained a position with NSHE, during the previous calendar year prior to the contract start date. However, when a former employee has moved out of state and provides service, this restriction does not apply.

In an IRS audit, agents almost always examine whether an employer wrongly classified employees as independent contractors. If the IRS discovers any failure to comply with federal rules and regulations, both the University and the individuals are subject to substantial financial penalty. When the compliance failure is due to the incorrect and/or incomplete information provided to the Accounts Payable Department by the department and/or by the independent contractor, the responsible department will be required to absorb these costs.

U.S. TAX INFORMATION FOR NONRESIDENT ALIEN INFORMATION SHEET

The Internal Revenue Service (IRS), the U.S. government tax authority, has issued strict regulations regarding the taxation and reporting of payments made to non-United States citizens. As a result, the University and Nevada System of Higher Education (“NSHE”) may required to withhold U.S. income tax and file reports with the IRS in connection with payments made by the NSHE to consultants and guest speakers who are not U.S. citizens or permanent resident aliens (greencard holders) and who receive compensation for services performed and/or reimbursement for travel.

The NSHE must determine whether you will be treated as a “resident alien” or “nonresident alien” for U.S. tax purposes. Consultants or guest speakers who enter the U.S. under a visitor’s visa (e.g., B-1 or B-2) or a waiver of a visa (e.g., WB or WT) are generally treated as nonresident aliens if they are present in the U.S. for a total of less than six months over a three year period. Consultants or guest speakers who are present in the U.S. under a J-1 visa are usually considered nonresident aliens for the first two calendar years that they are present in the U.S.

The NSHE is generally required to withhold taxes for all payments made to nonresident aliens. In order for the NSHE to make a correct determination about tax withholding, all guest speakers who are not citizens or permanent resident aliens of the U.S. must complete the Alien Information Collection Form and return it to the NSHE department that issued the initiation to speak. Once your U.S. tax status has been determined, if you are a nonresident alien, a tax equal to 30 percent is generally required to be withheld. Taxable items include, but are not limited to:

Honoraria Consulting Fee Compensation Speaker Fee Living Allowance Cash Award

The U.S. maintains income tax treaties with over 50 countries, and certain taxable payments made by the NSHE to you may be exempt from U.S. tax based on an income tax treaty entered into between the U.S. and your home county. The existence of a tax treaty does not automatically ensure an exemption from taxation; rather, you must satisfy the requirements for the exemption set forth in the tax treaty. In order to be considered for a tax treaty exemption, you must complete Form 8233. You must complete Form 8233 and return it via facsimile or post to the NSHE department that invited you to speak. A 30 percent withholding tax will be deducted from compensation payments made to consultants or guest speakers (i) who are from countries that do not maintain an income tax treaty with the U.S., (ii) whose payment does not qualify for exemption under a tax treaty, or (iii) who does not complete From 8233 in a timely manner.

If From 8233 is submitted after the NSHE has deducted tax from a payment to you, the NSHE cannot refund the tax to you; you must file a U.S. income tax return at year-end to apply for a refund of tax withheld from the IRS. Please note that the NSHE is also required by law to report to the IRS all payments made to a nonresident alien, or a third party on his or her behalf, regardless of whether the payment is subject to U.S. tax.

All individuals who receive payment from the NSHE are also required by law to disclose their U.S. social security or individual taxpayer identification number, he or she is required to complete From W-7 and submit the form and supporting documentation in person to the Assistant Controller for the Accounts Payable Department.

______________________________________________________________________________

All consultants and guest speakers who are not citizens or permanent resident aliens of the U.S. are required to complete tax information forms prior to receiving any payment. If you have additional questions about how to complete the required forms or need information concerning tax-withholding obligations, please contact the Assistant Controller for the Accounts Payable Department at 702.895.1143

SECTION TWO:

Worker Classification Questionnaire

Name of Worker ____________________________________________________Dba (name of business):

____________________________________________________________Address:

____________________________________________________________

Social Security Number:________________________

EIN# (if applicable):____________________

Department:_________________________MS_______Phone________Fax_________

Questionnaire completed by: ____________________________________(Dept. or Worker may complete)

NOTE: ALL QUESTIONS MUST BE COMPLETED. ANY ANSWER WITH UNKNOWN OR N/A WILL CAUSE THE FORM TO BE REJECTED.

Instructions & Training1. Please describe the services below to be performed and provide worker’s job title.

2. Describe the worker’s business/firm.

3. List all the specific details that will be given to the worker about the services to be performed. Include: 1). How does the worker receive work assignments? 2). Who determines the methods by which assignments are performed? 3). What routines/patterns will be followed? 4). What order/sequence will be followed?

4. What types of reports are required from the worker? (Attach examples if applicable).

5. Describe the worker’s daily routine (i.e., schedule, hours, etc.)

6. Who will decide where to purchase supplies or services necessary for the job?

7. How many assistants will the worker hire to assist him/her with the job, and will UNLV or the worker pay the assistants?

Financial Control

8. List any significant investment that the worker has in their business relative to his/herIndustry.

9. List the tools or equipment, and expenses (all resources) that UNLV and the worker will use to perform the service(s) including where the work will be performed.UNLV Provides: (include office space, computer, etc. if applicable)

Worker Provides:

10. What economic loss or financial risk, if any, can the worker incur beyond the normal loss of salary?

11. Describe how the worker advertises their services to the public (yellow pages, word ofmouth, etc).

12. List clients/customers that the worker provides these services for (provide address, phone if applicable)

13. What is the method of payment to this worker (hourly, monthly, shift, flat fee, invoiced as work progresses)? And what is the estimated cost of service to be paid to the worker?

14. Does worker have their own workman’s comp coverage through their firm should they become injured while providing services? And what is the risk of injury that the worker may sustain for the projected service(s) to be performed? Attach insurance coverage documentation.

15. Does the individual have a business license and insurance? Please attach copy of business license & insurance info. (Payments may be able to be processed off a purchase order – call for more details).

Relationship of the Parties

16. Is there a written agreement/contract between UNLV and the worker? (If yes, pleaseattach).

17. List any benefits that UNLV will provide to the worker (insurance, education, travel,

other).

18. How much notice will be given to UNLV should the worker decide to terminate this arrangement?

19. How much notice will be given to the worker should UNLV decide to terminate this

arrangement?

20. What sort of situations would require the dismissal of the worker?

21. Estimate the worker’s time on UNLV campus providing services for this job.

22. How long is the service for this job expected to last? (If indefinitely, explain).

23. List the departments here on campus that may require the same services, and/or if the

worker is already providing services to other departments.

24. List the special skills/training that the worker possesses.

Fax to 702.895.1519 or email to Yvette.Walton@unlv.edu:

1) THE WORKER CLASSIFICATION FORM 2) W-9 OR W-8BEN AND:3) INSURANCE REQUIREMENTS OR AFFIDAVIT OF REJECTION OF COVERAGE OF

WORKERS’ COMPENSATION

Do not continue until you have received approval and notification of the vendor number by email.

______________________________ __________ Approved Date

Payments are subject to1099 or 1042-S (if a nonresident alien) reporting guidelines.

or

Under penalties of perjury, I certify that: 1 The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2 I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3 I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. See the instructions on page 4.

Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Insurance Requirements

High risk activities involving aircraft, boats, and chartered buses will require higher limits than discussed below. Contact the Risk Management Office for insurance requirements. The Contractor shall, at Contractor’s sole expense, procure, maintain and keep in force for the duration of the Contract the following conforming to the minimum requirements specified as follows:

1. Worker’ Compensation and Employer’s Liability Insurancea. Does the Contractor have employees? Yes No

Sign Signature ofHere U.S. person Date

General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a

U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income

from a U.S. trade or business is not subject to the withholding tax on foreign partners’ share of effectively connected income. Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7).

If the answer to question a. is yes, the Contractor shall provide proof of Worker’s compensation insurance as required by NRS 616B.627 or proof

that compliance with the provisions of Nevada Revised Statutes, Chapters616A-D and all other related Chapters, is not required.

b. Nevada law allows the following to reject workers’ compensation

Coverage if they do not use employees or subcontractors in theperformance of work under the contract. Indicate the appropriate Category below:

Individuals/Sole proprietors (NRS 616B and NRS 617.210) Unpaid officers of quasi-public, private, or nonprofit corporations (NRS 616B.624 and 617.207)

Unpaid managers of LLC’s (NRS616B.624 and NRS 617.207)

An officer or manager of a corporation or LLC who owns the Corporation or LLC (NRS 616B.624 and M+NRS 617.207)

If the Contractor has rejected workers’ compensation coverage underNevada law, the Contractor must indicate the basis for the rejectionof coverage above; and complete, sign, and have notarized an Affidavitof Rejection of Coverage. The affidavit form can be found in thispackage.

2. Commercial General Liability (Minimum Limits)a. Does the Contractor have a Commercial General Liability Policy? Yes No

If the answer to question a. is yes, the Contractor shall provide a Certificate ofInsurance for Commercial General Liability with the following minimum limits:

Each Occurrence $1,000.000Products/Completed Operations Aggregate $1,000.000Personal and Advertising Injury $1,000.000General Aggregate $1,000.000

If the answer to question a. is no; or if the Contractor limits do not meet therequirement shown above, contact the Risk Management Office.

3. Business Auto Liability Insurancea. Will the Contractor drive onto NSHE property and/or transport NSHE Yes No

employees or students? If the answer to question a is no, evidence of business auto liability insurance is not required.

b. Does the Contractor have a Business Auto Liability policy?Yes No

If the answer to questions a & b is yes, the Contractor shall provide a Certificate of Insurance for Business Auto Liability with the following minimum limits for owned, Non-Owned or Hired Automobiles:

Per Accident, Combined Single Limit $1,000.000

If the answer to question b is no, contact the Risk Management Office

SECTION THREE________________ ____________________ ICA# Vendor #

INDEPENDENT CONTRACTOR AGREEMENT (ICA)

Payment Information

All information is required (Fill in all blanks, omitting any information may delay processing):

Service Provider Payment Information:

FULL NAME ______________________________ _____ ______________________________________Last Name (Please Print or Type) MI First Name

U.S. TIN/Social Security Number ____________________________________________________Payee must complete Form W-9 (if a U.S. Citizen) or W-8BEN (if International

Engagement Date(s) _________________________ to ______________________________

Total Payment Amount $ ___________________________________________

Scheduled Payments Yes No(If Yes list payments) (Note: payment will be made after the last engagement date)

#1 $_______________ #7 $________________#2 $_______________ #8 $________________#3 $_______________ #9 $________________#4 $_______________ #10 $________________#5 $_______________ #11 $________________#6 $_______________ #12 $________________

Mailing Address (number)____________________________________________________________________(PO Boxes are not accepted)

City_______________________________State__________________________Zip___________________

A) Is the payee a current or former (within the current calendar year) employee of any institution of the Nevada System of Higher Education?

If the answer to question A is yes, do not proceed with this form. Process the payment on an employment document.

Yes No

B) Is the payee a member of the same household as a NSHE employee?

If the answer to question B is yes, do not proceed with this form. Under the Board of Regents “Conflict of Interest” policy (BOR Handbook, Title 4, Chapter 10), payment is not allowed.

Yes No

C) Is the payee a U.S. citizen or lawful permanent resident (green card holder)?

If the answer to question C is no, contact the Assistant Controller for A/P. “See information regarding U.S. tax information for Nonresident Alien Consultants and Guest Speakers, complete NRA collection information.

Yes No

ACCOUNT INFORMATION:FUND AGCY ORGN OBJT SOBJ AMOUNT

                             

TOTAL

Disposition of check if not to be mailed to the payee’s address:

                 

The Nevada System of Higher Education is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, or physical or mental disability in any program or activity it operates. The NSHE employs only United States citizens and individuals lawfully authorized to work in the U.S.

Payee must complete and attached Form W-9 (if a U.S. citizen/resident) or W-8BEN (if international)

PAYMENT AUTHORIZATION: Based on the above, AGREEMENT: I have read and agree to the It is my determination that the payee meets above representations and assert that they arethe guideline and requirements of this contract. true and correct.

_________________________________ __________ ___________________________ ________Authorized Accounts Signature Date Payee Signature Date

_________________________________ ________________________________________Printed Name of Authorized Signer Mailing Address (PO Boxes are not accepted)

_________________________________ __________ ________________________________________Department Mail Stop City State Zip

_________________________________ _____________________ ________________Department Contact Phone Number Fax Number

_____________________________ _____________________ ________________________________________Telephone Number Fax Number e-mail address

CONTROLLERS OFFICE REVIEW

By:____________________Date:_________

Contract Exhibits A, B and C. ICA # ________________

Exhibit A. Explain in detail what the contractor will do specifically what will be done by the contractor, where the work will be accomplished, and when the work will be completed).

Exhibit B. Indicate the total amount of payment and the date when the payment will be made. The date the payment will be made should be the ending date of this contract. If this contract exceeds 45 days in length and completion benchmarks have been agreed to and progress payments are to be made, indicate each benchmark and its associated progress payment dollar amount.

Exhibit C. List any special conditions that apply.

PAYMENT REQUEST FOR ICA CONTRACT #_______________

_________________________________ ___________________________VENDOR NUMBER: Date Prepared:_________________________________ ___________________________NAME: Prepared By:_______________________________________ ________________________________ADDRESS Telephone Number_______________________________________ ______________ __________________Need Check by: Department & Mail Sort Code

Scheduled Payment Due $_____________________ Period Covered __________-__________

Travel Expenses

(Must be submitted with original receipts, copies will not be acceptable and will delay or reduce payment):

Receipts Attached

Yes No

Airfare $_____________________

Lodging $_____________________

Ground Transportation $_____________________

Meals $_____________________(Maximum allowed $26.00 per day)

Fuel $_____________________

Parking $_____________________

Other: $_____________________

Total Due ICA $_____________________

Approved Date Approved Date