Congressional District Programs 6201 Leesburg Pike * Suite 403 Falls Church, VA 22044
Phone: 800.986.4483 Fax: 703.820.5100 Email: email@example.com
EMPLOYMENT AGREEMENT FOR AN INDEPENDENT CONTRACTOR
To be filled out by the contractor
Contractor Name: Street Address: City, State, Zip:
SSN/Tax ID: Telephone: ( E-Mail:
(Completed IRS Form W-9 must be on file or accompany this contract; you will receive a 1099 at the end of the year.)
The name of the Project at CDP for which you propose to work: ___________________________________________________ Project # (if known):___________________ What do you propose to do? Please provide details:
___________________________________________________________________________________ ___________________________________________________________________________________________________ ________________________________________________________________________________________________________ ___________________________________________________________________________________________
Attach seperate sheets as necessary. Once the work is completed we require you to send an invoice for your work to the Manager of your Project at CDP named above. This person will forward the invoice to CDP to request payment. You must also fill out the Project Activity Report and submit it to CDP for our files.
What is your proposed compensation per hour? $________ How would you justify receiving this payment? Is it based upon your earnings history, the difficulty of the task, the payment generally accepted for like work?
______________________________________________________________________________________ _______________________________________________________________________________________ _____________________________________________________________________________________ __________________________________________________________________________________________
Are you the Program Manager?
Yes (if Yes, please skip the following three questions.)
We are asking for results only. You certify that you: 1.) Are not using office space furnished by the Project. 2.) Are not using tools furnished by the Project. 3.) Are not spending certain time in a a location required by the Project. This is true This is false (please explain): ________________________________________________ The maximum extent of the source of funds to pay for this person on payroll is limited to such funds as are credited to the account this Project at CDP, not to the assets generally of CDP. You agree to indemnify and hold harmless CDP (including legal fees) if you assert a claim against any assets of CDP other than funds designated for this Project at CDP. Please Initial: _______
Contractor Signature:_________________ Print Name:__________________ Date:____/____/____
CDP STAFF USE ONLY
Authorized Signature: _______________________________ Date:_____/_____/_____