Independent Contractor Agreement - Get as DOC - DOC by zSGm9zrS

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									                      Step Up Therapy Services
                                                       rd
                                1100 Coney Island Ave, 3 Fl, Brooklyn, NY 11230
                                   Phone (718)434-1200; Fax (718)434-1099

____________________________________________________________________________________

                      Independent Contractor Agreement

This Agreement is made between Step Up Therapy Services, PLLC (Client), with a principal place of
business at 1100 Coney Island Ave, 3rd floor, Brooklyn, NY 11230 and __________________________
(Contractor), with a principal place of business at __________________________________________.

    1. Term of Agreement

This Agreement will become effective on _____________________, and will end no later than June 30,
2012.

    2. Services to Be Performed

Contractor agrees to perform the following services: special education individual instruction to
preschool child with disability as mandated on child’s Individual Education Program approved by the
NYC Department of Education.

    3. Payment

In consideration for the services to be performed by Contractor, Client agrees to pay Contractor
$______ per hour of instruction according to the terms set out below.

    4. Terms of Payment

Upon completing Contractor’s services under this Agreement, Contractor shall submit all required
documentation, as described in Exhibit A and an invoice by the fifth of the month for every preceding
month. Client shall pay Contractor the compensation described within a reasonable time after receiving
Contractor’s invoice.

Client shell has the sole right to bill NYC Department of Education for the services rendered by
Contractor under this Agreement. During the term of this agreement and for a reasonable amount of
time thereafter, Contractor hereby assigns to Client the right to bill and collect for the services under
this Agreement. Contractor agrees to promptly execute any and all agreements or documents that
might be required by any third party payer in order to effectuate the assignment of Contractor’s billing
and collection rights.


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    5. Expenses

Contractor shall be responsible for all expenses incurred while performing services under this
Agreement. This includes license fees, memberships, and dues; automobile and other travel expenses,
meals and entertainment; insurance premiums, etc.

    6. Representations and Warranties

Contractor represents warranties and promises to the Client as follows:

    (a) At all times during the term of this Agreement Contractor shell hold NY Special Education or NY
        Special Education (b – 2) professional certificate.
    (b) Contractor’s Special Education certificate in New York State or any other state has never been
        suspended, revoked, annulled, or restricted.
    (c) Contractor has never been investigated, reprimanded, censured, sanctioned, or otherwise
        disciplined by any governmental or private entity.
    (d) No claim, action or proceeding based on allegation of professional misconduct by the Contractor
        has ever been asserted or instituted, and to Contractor’s best knowledge, no basis for any such
        claim or action has ever been in existence.

Contractor will disclose to the Client:

    (a) Existence of, and bases for any proceeding against Contractor ever instituted by any person or
        governmental or private entity which involves any allegation of substandard services, abusive
        conduct, or professional misconduct raised against Contractor, and
    (b) Any allegation of substandard services, abusive conduct, or professional misconduct raised
        against Contractor, by any person or governmental or private entity during the term of this
        Agreement.

In all other instances Contractor shell makes a disclosure in writing immediately upon becoming aware
of such information.

    7. Independent Contractor Status

Contractor is an independent contractor, not Client’s employee. Contractor’s employees or contract
personnel are not Client’s employees. Contractor and Client agree to the following rights consistent with
an independent contractor relationship:

(a) Contractor has the right to perform services for others during the term of this Agreement.

(b) Contractor has the sole right to control and direct the means, manner, and method by which the
services required by the Agreement will be performed.

(c) Contractor has the right to perform the services required by this Agreement at any place, location, or
time, consistent with the requirements of NYC Department of Education.


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( d ) Contractor will furnish all equipment and materials used to provide the services required by this
Agreement.

( e ) Contractor has the right to hire assistants as subcontractors or employees in order to help
Contractor to fulfill requirements of this Agreement.

( f ) Client shall not hire, supervise, or pay any assistants to help Contractor.

( g ) Neither Contractor nor Contractor’s employees or contract personnel shall receive any training from
Client in the skills necessary to perform the services required by this Agreement.

( h ) Client shall not require Contractor to devote full time performing the services required by this
Agreement.

    8. Business Permits, Certificates, and Licenses

Contractor has complied with all federal, state, and local laws requiring business permits, certificates,
and licenses required to carry out the services to be performed under this Agreement.

    9. State and Federal Taxes

Client will not:

( a ) withhold FICA (Social Security and Medicare taxes) from Contractor’s payments or make FICA
payments on Contractor’s behalf

( b ) make state or federal unemployment compensation contributions on Contractor’s behalf, or

( c ) withhold state or federal income tax from Contractor’s payments.

Contractor shall pay all taxes incurred while performing services under this Agreement - including all
applicable income taxes and, if Contractor is not a corporation, self-employment (Social Security) taxes.
Upon demand, Contractor shall provide Client with proof that such payments have been made.

    10. Fringe Benefits

Contractor understands that neither Contractor nor Contractor’s employees or contract personnel are
eligible to participate in any employee pension, profit sharing, health, vacation pay, sick pay, or any
other fringe benefit plan of Client. Contractor expressly waves Contractor’s rights to any benefits to
which he or she was, or may become, entitled.

    11. Worker’s Compensation

Client shall not obtain worker’s compensation insurance on behalf of Contractor or Contractor’s
employees.

    12. Unemployment Compensation


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Client shall make no state or federal unemployment compensation payments on behalf of Contractor or
Contractor’s employees or contract personnel. Contractor will not be entitled to these benefits in
connection with services performed under this Agreement.

    13. Insurance

Client shall not provide any insurance coverage of any kind for Contractor or Contractor’s employees or
contract personnel. Contractor agrees to maintain an insurance policy of at least $1,000,000 per
occurrence, $3,000,000annual aggregate to cover any negligent acts committed by Contractor or
Contractor’s agents while performing services under this Agreement. Contractor shell notifies Client in
writing within 5 business days of any changes to Contractor’s insurance.

    14. Indemnifications

Contractor shall indemnify and hold Client and its directors, officers, employees, volunteers, and any
other agents at harmless from any loss or liability, claims, damages, and expenses, including legal fees
and court costs arising from performing services under this Agreement at all times during and after the
term of this Agreement.

    15. Terminating the Agreement

With reasonable cause, either Client or Contractor may terminate this agreement, effective immediately
upon giving written notice.

Reasonable cause includes:

( a ) a violation of this Agreement, or

( b ) any act exposing the other party to liability to other s for personal injury or property damage, or

( c ) criminal conviction, or engagement in any conduct constituting a criminal act, or

( d ) imposition of a Civil Monetary Assessment (not including routine audits or billing inquiries), or

( e ) it is determined that the party have been engaged in any illegal or unauthorized activity under the
Fraud and Abuse Laws by the government agency or court of competent jurisdiction, or

( f ) Contractor’s license is suspended, revoked, annulled, or restricted, or

( g ) Contractor commits an act or omission that in the good faith and reasonable belief of Client is
fraudulent and/or jeopardized or could have jeopardized the health, treatment, or safety of a child.

    16. Exclusive Agreement

This is the entire Agreement between Contractor and Client.

    17. Severability


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If any provision of this Agreement is determined to be invalid, illegal, or unenforceable, the remaining
provisions will remain in full force if the essential provisions of this Agreement for Client and Contractor
remain valid, binding, and enforceable.

    18. Applicable Law

This Agreement will be governed by the laws of the state of New York; federal, state and local statues;
regulations and guidelines established by the NYC Department of Education; HIPPA laws; and generally
accepted professional and ethical standards and practices.

The county of Kings in the state of New York is designated as the exclusive forum for any action or
proceeding arising from or in any way connected to this Agreement.

    19. Notices

All notices and other communications in connection with this Agreement shall be in writing and shall be
considered given as follows:

( a ) when delivered personally to the recipient’s address as stated on this Agreement, or

( b ) three days after being deposited in the Unite States mail, with postage prepaid to the recipient’s
address as stated on this Agreement, or

( c ) when sent by fax or email to the last fax number or email address of the recipient known to the
person giving notice.

 Notice is effective upon receipt provided that a duplicate copy of the notice is promptly given by the
first class mail, or the recipient delivers a written confirmation of receipt.

Notices may be signed by attorneys for the party sending the notice.

    20. No Partnership

This Agreement does not create a partnership relationship. Contractor does not have authority to enter
into contracts on Client’s behalf.

    21. Assignment

Contractor may not assign, delegate, or subcontract any rights or obligations under this Agreement
without Client’s prior written approval.




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      22. Signatures

Contractor:
_______________________________________ (corporation’s name)

By:         _________________________________ (signature)

           __________________________________ (typed or printed name)

Title:     __________________________________ Date: _____________________

Taxpayer ID Number ______________________

Fee: (Evaluation)__________________ ( Service)_____________________________

Step Up Therapy Services, PLLC
By:         _________________________________ (signature)

           __________________________________ (typed or printed name)

Title:     __________________________________                              Date: _____________________




                                                                 Exhibit A
The authorized services on the Individual Education Plan (IEP) must be followed. It is Contractor’s responsibility to review and interpret IEP
educational goals to ensure quality and authorized quantity of the services.

Contractor is responsible for providing own copies of all forms required by the NYC Department of Education.

If Contractor is not able to provide services under this Agreement he/she shell notify Client immediately.

If Contractor has a professional opinion that IEP mandate should be increased or decreased, and/or educational goals modified, Contractor
shell write rationale for these changes as required by the NYC Department of Education. Contractor shell proceeds with such changes upon
approval by the NYC Department of Education.

Parent/Guardian/Day Care Director shall sign Contractor’s session time sheets after each session.

All sessions must be done with a Parent/Guardian/Day Care Teacher present in the room.

There should be a Progress Report every three month starting September as required by NYC Department of Education.

Eleven months past the IEP date a Yearly Progress Report with new IEP goals and pages 2-6 of a new IEP are required by the NYC DOE.

Contractor shell attends IEP meetings at the NYC DOE District.

If a student turns five years old during calendar year, a Turning Five Report (same as Yearly Progress Report) is required by the NYC DOE by
March 1 regardless of the IEP date.

All documentation shell have student’s name, address, and NYS IEP ID # (OSIS #), and Contractor’s original signature.


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