Short Independent Contractor Contract by its10491


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									                           Accounts Payable                                    Contact Person:
    SEAL                  Consultant Requisition                                     Department:
                                  Form                                                       Date:                     Extension:


  This form is required to request consultant services, confirm funding availability and encumber the contract amount in the
  university accounting system for all contracts of $1,500 or more and for honoraria or research consultation payments in
  excess of $5,000.


Vendor Name:                                                                                     Tax ID - SSN \ ITIN \ EIN:

  Address:                                                                   Visa Status
                                                                               US Citizen               B2 / VWT          F-1
City:                                                                          Green card               B-1 / VWB        J-1
                                                                                                                  W-8BEN Required
                                                                             W-9 Required
  State:                              Zip:                                                             (also, may be subject to 30% withholding)

  Country:                                                                   Work to be done
                                                                                 In the US                   Outside the US
    Scope of work and summary of services provided

        Contract Dates                                                                               Funding Source
                            Start:                             End:                                      University Funded           Grant Funded

  Service Costs may not exceed:                                        Expense reimbursements may not exceed:

  Total contract amount may not exceed:                                                                Read about large contracts

        We will use the template contract           Documentation       Total number of payments                                    to be charged to:

    Account      (4)     Fund   (2)     DeptID       (5)    Program    (5)       Project/Grant       (6,9)          Amount

                                                                                                       Total:                0.00
University Approval

  I have reviewed the scope of the work and estimated cost of the requested consultant services and approve
  this request. I understand that no work may begin until Accounts Payable approves independent contractor
  status and a contract is signed.

  Department Head/P.I.                       Date          Budget Manager or Dept Head.         Date

  Dean or Assoc. VP if >$10k                 Date          Executive VP if > $100K              Date

  Grant Funded for Consultant \ honorarium in excess of $5,000: By signing, P.I also certifies that the
  consultant is needed, a selection process was employed, fee is appropriate, and funds to pay are both
  uncommitted and approved by sponsor.

                                                                                                                                               12 Oct 2005
Determine Consultant Status
 Vendor Name:                                                                       Tax ID - SSN \ ITIN \ EIN:


 City:                            State:              Zip:


   1. Is the proposed consultant a former Brandeis employee or student?                                   Yes    No

   2. Do they provide similar services to other clients and or business outside the
   university? Please attach a copy of their business card, copy of their                                 Yes    No
   advertisement, or letterhead to this form.
   3. Do they engage in entrepreneurial activities in an established business, at
   risk for profit or loss?                                                                               Yes     No

   4. Will they receive any training, supervision, or instruction from Brandeis
   University other than conveying the scope of services desired?                                         Yes    No

   5. Will they be responsible for determining means and methods to use to
   perform services?                                                                                      Yes    No

   6. Will they provide their own supplies, equipment, forms, etc. necessary to
   perform services?                                                                                      Yes    No

   7. Do they maintain sufficient insurance to protect against work related
   injuries and damage to University property?                                                            Yes    No

   8. Will they set their own priorities on time, amount of effort, and hours of
   work to accomplish services within stated time frame?                                                  Yes    No

   9. How will they be paid?                                                                     Hourly Rate     Set Fee

   10. Will they have control over hiring or supervising Brandeis University
   employees?                                                                                             Yes    No

   11. Is this the first time they will perform services for Brandeis University?                         Yes    No

   12. If “no” to #11, what other department(s) at Brandeis have used this

   I certify that the above information is accurate and complete to the best of my knowledge.

   Signature of requester:                                                     Date:

     AP use only

         [C] Agreement Number

     Encumbered amount                                       Date:                     Name:

     New Vendor: _______             Vendor Short Name: ________________                W-9 ___ W-8BEN ___

                                       Approved by: _________                             Date: ___________
                                                                                                                 12 Oct 2005
Consultant Requisition from
This form should be used to:
* request determination of a consultant’s status as an independent contractors and
* to establish an encumbrance of the budget for the amount of the contract.
Use the form in conjunction with the University’s Consultant Policy
We recommend that you use MS-Excel to fill in this form. After filling the form print it, attach the
required documentation and send to Accounts Payable, MS 110. This form can also be printed and
filled in manually.
 * You can use the ‘Tab’ key to move between boxes. Use ‘Shift + Tab’ to move backwards.
 * Some data fields in this two page form repeat on both pages. If you are using Excel to fill in this
form, tying the information in the first page will auto fill the equivalent fields on page two.
 * Required fields are highlighted; the highlighting will disappear once the data is keyed in. Check
boxes and radio buttons are not highlighted, but they are all required fields.
 * Some links throughout the form are named 'Documentation'. Use them to get to a task specific
Immigration and Tax:
 * This form contains some questions about the non-employee immigration status. Please be sure to
ask the person to conplete form W-9 if they are a US person or form W-8BEN if they are a non resident
alien (NRA). Both forms are available at the IRS web site (
 * Brandeis students receiving prizes or awards do not have to complete form W-9 or W-8BEN.
 * Please work with the International Students and Scholars Office (ISSO -
when inviting foreign nationals to the University.
 * Payments to NRA’s are subject to 30% withholding, unless exempt by tax treaty or are foreign
source income. Contact Accounts Payable for more information concerning tax withholding before
you invite or contract a NRA.
Scope of work: There is a text box where you can describe the scope of work the consultant will do
for Brandeis. The box is comprised of two Excel cells, each cell can contain up to 255 characters. The
255 character limit is an Excel constraint. If you need additional space, please attach a separate page
and be sure to write the consultant’s name on that page.
Template Contract: Brandeis University strongly recommends the use of a template contract for
procurement of personal services from independent contractors. The contract is available on our web
site The Vice
President for Financial Affairs & Treasury Services approves all contract other than the template
contract and is the only individual authorized to do so on behalf of Brandeis Uninversity. Print the
contract at:
Contracts larger than $25,000: Brandeis University's Procurment Policy requires that for contracts
larger than $25,000 three written bids or a sole source justification be submitted. Please attach the bids
or sole source justification to this requisition. Accounts Payable will forward the material to
Procurement Services.

d51fc4f5-278a-4b87-9b28-3c3d1a61ea66.xls - Documentation                                          page 3 of 3

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