This Agreement is being signed on ___________________________between
_____________________ (myself, as the Independent Contractor providing supports)
and _____________________________ (the person contracting my support services).
___________________________ will be the key contact(s) for ____________________.
The purpose of this Agreement is to make sure that everyone who is signing this
understands and agrees to the responsibilities listed and how payment for the
supports will be made.
This Agreement for providing personal support will begin on
____________________ and be finished on ____________________.
As the independent contractor, I am contracted for
_______ hours per week.
From time to time, support requirements may change and as a result the number
of hours may vary accordingly. Any change will be mutually agreed upon.
This contract includes the use of an automobile
If yes, I will provide an automobile and $1,000,000.00 Third Party Liability
1. SUPPORT PLAN
As the Independent Contractor, I will assist ___________________ to achieve the
goals, explained in the Outcomes that are provided by ________________.
2. EMPLOYMENT STATUS
It is understood that I ______________________________as the Independent
Contractor have explored and understand the implications of being an
Independent Contractor for this contract.
The fee for the provision of personal supports has
been set at $______________ per hour.
The fee for the use of my vehicle while travelling
with ___________________ is $ ______________.
All other expenses related to providing this personal
support is included in the fee or requires further
I will be responsible for claiming my own income and income tax.
A T-4 income tax form will not be issued.
3.1 Claiming Payment/Reimbursement
Hours will be written on an invoice and then submitted for
every two weeks
*See attached sample INVOICE.
The person, Key Contact(s) and or a designate, will sign the invoice, approving the
hours worked, etc.
All information will be kept private and confidential.
Any release of information requires written permission from
______________________ and/or the key contact(s).
5. REVIEW OF AGREEMENT
This document is in effect for ____ month(s). At that time it will be reviewed, unless
everyone has agreed to change it before that.
6. TERMINATION OF AGREEMENT
If anyone who signs this agreement wishes to end it before the finish date, they
can give two weeks notice.
Both of us have the right to change the Agreement with two weeks notice in writing. The
notice period can be different if everyone agrees. This Agreement may be finished
without notice, if there is a breach of a fundamental term of this Agreement such as any
wilful misconduct, or if this contract cannot be completed, or I, as the independent
contractor, did not do what I signed that I would do.
I agree to provide supports as stated in this Independent Contractor Agreement.
_______________________ and the Key Contact(s)
agree to contract for the supports as stated in this
Independent Contractor Agreement.
Person contracting for supports