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This is a statement by a contractor or vendor stating his/her acknowledgment of obligations to adhere to client's policies and procedures, code of conduct and the status of the contractor of an independent contractor and not of an employee of the client.
Independent Contractor Acknowledgement This is a statement by a contractor or vendor stating his/her acknowledgment of obligations to adhere to client's policies and procedures, code of conduct and the status of the contractor of an independent contractor and not of an employee of the client. ALL INFORMATION AND FORMS ARE PROVIDED “AS IS” WITHOUT ANY EXPRESS OR IMPLIED WARRANTY, INCLUDING AS TO LEGAL EFFECT OR COMPLETENESS. They are for guidance and should be modified by you or your attorney to meet your specific needs and the laws of your state. Use at your own risk. Docstoc, its employees or contractors who wrote or modified any form, are NOT providing legal or any other kind of advice and are not creating or entering into an Attorney-Client relationship. The information and forms are not a substitute for the advice of your own attorney. Subject to our Terms of Service (http://www.docstoc.com/popterm.aspx?page_id=15). See back cover page and read more here (http://www.docstoc.com/popterm.aspx?page_id114) for additional disclaimers and © Copyright 2011 more. This document Docstoc Inc. registered documentis not approved, endorsed by, or affiliated with any State, or proprietary, copy not governmental or licensing entity. 1 Entire document © Docstoc, Inc., 2010, 2011 INDEPENDENT CONTRACTOR ACKNOWLEDGEMENT The undersigned certifies that he/she a duly authorized independent contractor or vendor (“Contractor”). Contractor certifies that Contractor has received and reviewed Company and its affiliates, 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 agreements 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. Contractors acknowledge 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. 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 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 contractors under the law of United States of America or other jurisdictions; © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 2 c) solely responsible for providing superannuation, sickness benefits and work cover or their counterparts in other jurisdictions; d) solely responsible for ensuring compliance with all relevant federal, state and local with respect to provision of the services. Name of Contractor: ________________________________________________ Signed: __________________________________________________________ Print Name: ______________________________________________________ Title: ____________________________________________________________ Date: ___________________________________________________________ © Copyright 2011 Docstoc Inc. registered document proprietary, copy not 3
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