Contract Manager Submissions

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APPLICATION TO RETAIN THE SERVICES OF AN INDEPENDENT CONTRACTOR $5,000 AND ABOVE

The information requested upon this Independent Contractor Application form is used to allow the Research Foundation to make a proper determination if the worker can be classified as an Independent Contractor under the IRS guidelines for determining worker status. No Contractor may begin work until an Independent Contractor Agreement has been executed by the Contractor and the Research Foundation.

Please do not use this form for Independent Contractor Agreements less than $5,000. Instead please submit as an MOU at CUNY SPS ICA under $5,000.

Please allow 1-3 business days for the SPS Grants Office to process your request. RFCUNY Legal review typically takes 3-4 weeks from when the Grants Office submits your contract request.

CUNY Contact

Name of submitter*

First Name

Last Name

Program Name*

Does this Contract need to be charged to multiple RF account numbers?*

If you answer yes, fields will appear in the Agreement section to split the amount.

RF Account Number*

XXXXX-XX XX

RF Account Number 2

XXXXX-XX XX

RF Account Number 3

XXXXX-XX XX

Phone Number

Email*

Date Submitted*

Agreement

Request for*

New Agreement Amendment

Performance Period Start*

Performance Period End*

Total Amount of Agreement* $

For agreements less than $5000, please stop and complete https://cunyspsgmrlu.formstack.com/forms/mou_procurement.

Amount RF Account 1 $

Amount RF Account 2 $

Amount RF Account 3 $

Amount of Amendment* $

Enter negative number if decrease, positive if increase.

Contractor Information

Contractor's name*

Contractor's website

Is the contractor a full-time CUNY employee?*

Yes No

“Yes”, CUNY approval MUST be attached

Is the contractor an RFCUNY employee?*

Yes No

If “Yes”, this ICA cannot beprocessed. RFCUNY employees cannot also be classified as Independent Contractors under the IRS/Department of Labor guidelines. The individual should instead perform the work as an employee.

Has CUNY employed or retained the services of the Contractor in the past?*

Employee Contractor None

Name of contractor's authorized signatory*

First Name

Last Name

Phone of authorized signatory*

Email of authorized signatory*

Has the Contractor provided a W-9 form?*

Yes No

Does the contractor have an SSN?*

If business entity, select EIN. If individual, select SSN.

Other

Is Sponsor approval required for this ICA?*

If “Yes”, a copy of the Sponsor’s approval MUST be included with your request.

Does the Scope of Work contain any statements regarding representations, obligations, assumptions, deadlines, deliverables or responsibilities on the part of CUNY?*

No Yes

Please note that checking “Yes” constitutes a confirmation of the following: (1) All representations, obligations, assumptions, deadlines, deliverables or responsibilities attributable to CUNY contained within the Scope of Work are correct and accurate; (2) The program understands, accepts, and agrees to assume responsibility for complying with all such representations, obligations, assumptions, deadlines, deliverables or responsibilities applicable to CUNY under the attached Scope of Work