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Independent Contractor Acknowledgement

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This is a statement by a contractor or vendor stating his/her acknowledgment of their obligations to a client. The contractor acknowledges the client’s policies and procedures, code of conduct and approves their status as an independent contractor and not of an employee of the client. This document in its draft form contains numerous of the standard clauses commonly used in these types of agreements; however, additional language may be added to allow for customization to ensure the specific terms of the parties’ agreement are addressed. This agreement can be used by small businesses or other entities that want to hire an independent contractor.

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									This is a statement by a contractor or vendor stating his/her acknowledgment of their
obligations to a client. The contractor acknowledges the client’s policies and
procedures, code of conduct and approves their status as an independent contractor
and not of an employee of the client. This document in its draft form contains numerous
of the standard clauses commonly used in these types of agreements; however,
additional language may be added to allow for customization to ensure the specific
terms of the parties’ agreement are addressed. This agreement can be used by small
businesses or other entities that want to hire an independent contractor.
      INDEPENDENT CONTRACTOR ACKNOWLEDGEMENT
The undersigned certifies that he/she is a duly authorized independent contractor or vendor
(“Contractor”). Contractor, (identified as __________________) certifies that Contractor has
received and reviewed Company (known in full as __________________) and its affiliates, the
Code of Conduct and Ethics (“Code”) and fully understands the requirements set forth in the
Code.

Contractor certifies and acknowledges that Contractor shall act in full accordance with all
applicable Company policies and procedures in addition to statutory laws and regulations. These
policies and procedures include Company’s commitment to conduct its business in compliance
with the highest ethical standards.

Contractor’s failure to comply with the policies and procedures set forth in Company’s Code, or
failure to report violations of these policies and procedures may result in immediate termination
of Company’s agreement(s) with Contractor.

Contractor understands that Contractor has an obligation to conduct business within the
guidelines of the Code of Conduct that prohibit actual or potential conflicts of interests.
Contractor acknowledges and states that: (check one)

□ I do not have a conflict of interest
□ I may have a potential conflict of interest (explain below)
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Further Contractor acknowledges that Contractor shall comply with all applicable laws, by-laws,
ordinances, regulations, statutes, proclamations, orders and rules, and with the lawful
requirements of the relevant authorities as may be in any way related to the services provided by
Contractor. This compliance shall be extended to any new or changed law, by-law, ordinance,
regulation, proclamation, order rule or lawful requirement as may be in any way related to the
Services provided.

Contractor acknowledges that in providing the services agreed upon, the Contractor acts as an
independent contractor and not as an employee, partner or agent of the Company and the
Contractor shall have no authority to act for or to bind the Company in any manner whatsoever
other than as expressly contemplated by this Contract. Contractor acknowledges and agrees that
the Contractor is:

a)     not entitled to payment of salary, holiday pay, sick pay, severance pay, long service leave
or any other entitlement an employee has in respect of his or her employer;

b)     solely responsible for all payments in relation to any taxes such as but not limited to
income tax, pay-roll tax, sales tax or any other payments as may be imposed on in respect of


© Copyright 2013 Docstoc Inc. registered document proprietary, copy not               2
contractors under the law of United States of America or other jurisdictions; c)    solely
responsible for ensuring compliance with all relevant federal, state and local laws with respect to
provision of the services.




Name of Contractor: ________________________________________________
Signed: __________________________________________________________
Print Name: ______________________________________________________
Title: ____________________________________________________________
Date: ___________________________________________________________




© Copyright 2013 Docstoc Inc. registered document proprietary, copy not                3

								
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