1 INDEPENDENT SERVICE PROVIDER CONTRACT (ISP) INSTRUCTIONS FOR USE: The purpose of this form is to be used for contracts with individuals engaged in technical, professional or specialized skills such as guest speakers, athletic officials, consultants, performers and to request honorarium payments to individuals who: Provide one-time nonrecurring services. Are to be paid $10, or less (no receipts required, all payments reportable as taxable income); and Who are not otherwise employed by the Nevada System of Higher Education (which includes CCSN, DRI, and GBC, TMCC, UNLV, UNR, WNCC, or NSHE System Administration. Payment exceeding $10, and/or travel expenses are to be reimbursed after completing the engagement. Please see instructions to submit a UNLV Independent Contractor Agreement (ICA) for payments over $10, Before the ISP contract is initiated ISP status must be determined: Complete the Evaluation for Determining Independent Service Provider Status (page two of this package). If an individual is neither a U.S. Citizen nor a lawful permanent resident (green card holder), additional documents may be required, please see the last page of this package for additional information and contact the Assistant Controller for Accounts Payable at before proceeding with this ISP document. When negotiating this one time payment, determine if the payment will consist of a fee as well as travel expenses; remember the total of the contract MAY NOT EXCEED $10, Although recommended a traveler make his/her own travel arrangements, the department may prepay certain travel expenses, such as lodging, and airfare. Vehicle rental and arrangements are the sole responsibility of the traveler. Best Practice Example: Traveler to make own arrangements: Total cost to the department and payable to the traveler = $ the check may be available during the visit if requested. Alternative Example: Traveler with university prepaid arrangements: $ fee + $75.00 for two days of meals, less one hosted lunch + $ for Airfare prepaid by P-card, + $ for one day of lodging prepaid by P-card: Total department cost = $ hosted meal. Payable to Traveler = $ after the trip has ended. If meals and lodging are included in your contract negotiation, the daily allowance is $45.00; (Breakfast $10.00; Lunch $15.00; Dinner $20.00) If any hosted meal is anticipated, the meal allowance for that meal must not be considered in the allowance for that day. Lodging may not exceed $150.00/night, including any taxes for stay during Sunday Thursday, and $175.00/night, including taxes for stay during Friday - Saturday. These rates may be exceeded on a case-by-case basis, with proper approval of the President, Provost, Vice President, Dean or Director. Prepayment method - For travel expenses in cases were the payment to the individual is $10, or less, and you would like to offer transportation and lodging: Lodging may be prepaid by P-Card; Lodging may also be prepaid by UNLV by method of a payment voucher accompanied by the hotels confirmation of the reservation. Rental Vehicles are the responsibility of the contractor and may not be billed to a university contracted agency. Airfare may be prepaid by method of P-card or the Travel Authorization Form on the Accounts Payable web site at:: Once you have determined the status of the payee to be a true ISP and negotiated the contract: Complete and submit the signed ISP contract, a signed W-9 (if a U.S. Citizen) or (W-8BEN if international), the evaluation for determining ISP status, a flyer announcing the engagement, invitation letter or complete the exhibits page included in this package to: Accounts Payable mail stop 1053 for non-grant or non-nra s; send to the Office of Sponsored Programs mail stop 1055 if charging a grant account and to the n-resident Alien tax specialist mail stop 1015 if the person is not a U.S. citizen. DO NOT SEND THIS SHEET TO THE CONTRACTOR; KEEP FOR YOUR REFERENCE. SEND ONLY APPLICABLE PAGES TO THE CONTRACTOR. FAX SIGNATURES ARE ACCEPTED.
2 Evaluation for Determining Independent Contractor Status Hiring departments are responsible for providing information to properly classify individuals as employees or independent contractors. The following questions are intended to measure the extent of control which the University/NSHE may exercise over the worker. Generally, if there is a good deal of control over what the worker does and how the worker does the work, there should be an employee relationship established (EDOC). If there are few elements of control, an independent contractor relationship may be appropriate. 1. Must the service provider follow substantial instructions? If yes, describe the Type of direction and control and who will supervise the services: 2. Are substantive training, guidance, and/or assistance provided to the contractor? 3. Is the contractor s job substantively integrated in the general operation of the Department/University/NSHE? 4. Are services rendered personally by the contractor? 5. Does the contractor hire, supervise, and pay assistant workers? 6. Does the arrangement contemplate continuing or recurring work? If yes, explain: 7. Does the University/NSHE establish set hours of work? 8. Is there a full time requirement? 9. Will the service be performed on the University/NSHE premises? 10. Does the University/NSHE require that the work be done in a specific order or sequence? 11. Is regular accountability required? 12. Is payment by the hour/week/month as opposed to payment by the task/job completed? 13. Does the University/NSHE furnish equipment, tools or supplies to the contractor? 14. Can the contractor be discharged even if the contract terms are being met? 15. Does the contractor have the right to terminate without contract liability? 16. Is NSHE the only client for whom these or similar services are actively provided? 17. Has the contractor performed this or other services for the University/NSHE in the past? If yes, when? 18. Will business and travel expenses be the departments responsibility? 19. Will the department provide or invest in supplies and or equipment? 20. Will the individual depend solely on this contract for personal invoice?
3 ISP# Vendor # INDEPENDENT SERVICE PROVIDER CONTRACT (ISP) Payee Information All information is required (including answering questions A-C below): Service Provider Payment Information: FULL NAME Last Name (Please Print or Type) MI First Name U.S. TIN/Social Security Number Payee must complete Form W-9 (if a U.S. Citizen) or W-8BEN (if International) Engagement Date(s) to Total Payment Amount $ MM/DD/YY MM/DD/YY Check Due Date (t to exceed $10000 use ICA if above this amount) (t before end date) Mailing Address (number) (PO Boxes are not accepted) City State Zip A) Is the payee a current or former (within the current calendar year) employee of any institution of the Nevada System of Higher Education? If the answer to question A is yes, do not proceed with this form. Process the payment on an employment document. B) Is the payee a member of the same household as a NSHE employee? If the answer to question B is yes, do not proceed with this form. Under the Board of Regents Conflict of Interest policy (B/R Handbook, Title 4, Chapter 10), payment is not allowed. \ C) Is the payee a U.S. citizen or lawful permanent resident (green card holder)? If the answer to question C is no, contact the NRA tax specialist at See information regarding U.S. tax information for nresident Alien Consultants and Guest Speakers.
4 Independent Service Provider Contract (ISP) Account Information: Fund Agency Organization Object Sub-Object Amount Invoice: Description: t to exceed $10,000 tes on disposition of check if not to be mailed to payee s address: The Nevada System of Higher Education is an equal opportunity/affirmative action employer and does not discriminate on the basis of race, color, religion, sex, age, creed, national origin, veteran status, or physical or mental disability in any program or activity it operates. The NSHE employs only United States citizens and individuals lawfully authorized to work in the U.S Payee must complete and attached Form W-9 (if a U.S. citizen/resident) or W-8BEN (if international) PAYMENT AUTHORIZATION: Based on the above, It is my determination that the payee meets the guidelines for one-time, nonrecurring payment. AGREEMENT: I have read and agree to the above representations and assert that they are true and correct. Authorized Accounts Signature Date Payee Signature Date Printed Name of Authorized Signer Mailing Address (PO Boxes are not accepted) Department Mail Stop City State Zip Department Contact Phone Number Fax Number Telephone Number Fax Number address CONTROLLERS OFFICE REVIEW By: Date:
5 Contract Exhibits A, B and C. ISP/ICA # Exhibit A. Explain in detail what the contractor will do (specifically what will be done by the contractor, where the work will be accomplished, and when the work will be completed). Exhibit B. Indicate the total amount of payment and the date when the payment will be made. The date the payment will be made should be the ending date of this contract. If this contract exceeds 45 days in length and completion benchmarks have been agreed to and progress payments are to be made, indicate each benchmark and its associated progress payment dollar amount. Exhibit C. List any special conditions that apply. Form HRD-5011 May 08,1997
6 UNIVERSITY OF NEVADA LAS VEGAS/NEVADA STATE COLLEGE PHONE FAX VENDOR APPLICATION PROFILE Initial Application Revision Date VENDOR INFORMATION Employer Identification #/SSN #: Contractor s License #: Individual Taxpayer Identification Number (ITIN): (only if you are a Permanent Resident Alien without a Social Security Account.) Individual or Company Name: Legal Name: President s Name: (if different from above Individual/Company Name) Address: City: State: Zip: Phone: ( ) FAX: ( ) Address: LEGAL STRUCTURE Sole Proprietor Partnership Corporation Limited Liability Company n-profit Other : TYPE OF ORGANIZATION MINORITY OWNED BUSINESS - An independent business which performs a commercially useful function and is at least 51% owned and controlled by one or more minority persons of Black American, Hispanic American, Asian-Pacific American, or Native American ethnicity. WOMEN OWNED BUSINESS - An independent business which performs a commercially useful function and is at least 51% owned and controlled by one or more women. PHYSICALLY CHALLENGED BUSINESS - An independent business which performs a commercially useful function and is at least 51% owned and controlled by one or more disabled individuals pursuant to the federal Americans with Disabilities Act. VETERAN/DISABLED VETERAN - An independent business which performs a commercially useful function and is at least 51% owned controlled by one or more veterans/disabled veterans who have served in the active military and discharged under conditions other than dishonorable. and SMALL BUSINESS ENTERPRISE - An independent business which performs a commercially useful function, is not owned and controlled by individuals designated as minority, women, veterans, or physically-challenged, and where gross annual sales does not exceed $2,000,000. If you have checked any of the above, have you been certified? NO YES If yes, by what Agency? PRODUCTS AND/OR SERVICES OFFERED Advertising / Marketing Computer Software Furniture Medical Arts & Crafts Construction Contractors Class: Gasses/Fuel Musical Athletic Construction Materials Glass Office Supplies & Equip Audio/Visual Equipment Consulting Services Hardware, Locks & Tools Photography Automobiles & Equipment Custodial/Janitorial Hazardous Materials/Chemicals Printing Books & Publications Dental HVAC Security Catering Electrical Laboratory/Science Staffing, Temporary Collections, Financial Entertainment Landscaping Training Services Communications Fire Prevention Library Travel Computer Hardware Food Service and Equipment Mail/Delivery Service Uniforms & Clothing Other
7 Form W-9 Taxpayer Identification Number Request Rev. Mar For payments other than interest, dividends, or Form 1099-B gross proceeds Please complete the following information. We are required by law to obtain this information from you when making a reportable payment to you, and because the payment is reportable on an information return to the IRS, you are required by law to provide your correct Social Security Number or Employer Identification Number to us. If you do not provide us with this information, your payments may be subject to 30% federal income tax backup withholding (29% after December 31, 2003). Also, if you do not provide us with this information, you may be subject to a $50 penalty imposed by the Internal Revenue Service under section Federal law on backup withholding preempts any state or local law remedies, such as any right to a mechanic's lien. If you do not furnish a valid TIN, or if you are subject to backup withholding, the payor is required to withhold 30% of its payment to you (29% after December 31, 2003). Backup withholding is not a failure to pay you. It is an advance tax payment. You should report all backup withholding as a credit for taxes paid on your federal income tax return. Instructions: 1. Complete Part 1 by completing the one row of boxes that corresponds to your tax status. 2. Complete Part 2 if you are exempt from Form 1099 reporting. 3. Complete Part 3 by filling in all lines 4. Return this completed form to us in the enclosed envelope. Use this form only if you are a U.S. person (including U.S. resident alien). If you are a foreign person, use the appropriate Form W-8. If you were a nonresident alien and have now become a resident alien, read the note below and attach a statement, if necessary. te to U.S. Resident Aliens who formerly were nresident Aliens: If there is a tax treaty between the U.S. and your country and it contains a saving clause to exempt certain types of income from U.S. tax even after you have become a Resident Alien, and you want to claim that exemption, fill out all of this form AND attach a page showing: 1. The treaty country 2. The treaty article about the income 3. The article number for the saving clause 4. The type and amount of income that qualifies for the saving clause 5. Facts that provide a sufficient explanation of why the saving clause applies. Part 1 Tax Status: (complete only one row of boxes) Individuals: Individual Name: (First name, middle initial, last name) Individual's Social Security Number Sole Proprietor (or an LLC with one owner): A sole proprietorship may have a "doing business as" trade name, but the legal name is the name of the business owner. Business Owner's Name: (REQUIRED) Business Owner's Social Security Number Business or Trade Name (OPTIONAL) (First Name) (Middle initial) or Employer ID Number (Last name) Partnership (or an LLC with multiple owners): Name of Partnership: Partnership's Employer Identification Number Partnership's Name on IRS records (see IRS mailing label) Corporation, or Tax-Exempt Entity: A corporation may use an abbreviated name or its initials, but its legal name is the name on the articles of incorporation. Name of Corporation or Entity: Employer Identification Number Part 2 Exemption: If exempt from Form 1099 reporting, check your qualifying exemption reason below: Corporation te that there is no corporate exemption for medical and healthcare payments or payments for legal services. Tax Exempt Entity under 501(a) (includes 501 (c)(3)), or IRA The United States or any of its agencies or instrumentalities A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or agencies A foreign government or any of its political subdivisions or an international organization in which the United States participates under a treaty or Act of Congress Part 3 Signature: I am a U.S. person (including a U.S. resident alien). Person completing this form: Title: Signature: Date: Tax correspondence address: If address for payments is different, please list payment remit address below: City: State: ZIP: Phone: ( ) Please fax the completed vendor application to the requesting department at UNLV or NSC.
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