Certification For Personal Services Agreement
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OFFICIAL COLORADO STATE DOCUMENT
DO NOT ALTER THIS FORM
CERTIFICATION FOR PERSONAL SERVICES AGREEMENT
Instructions: Additional supporting documentation, such as the scope of work via a copy of the purchase
order or contract, must be attached to this completed form. Failure to complete this form in its entirety or
attach the scope of work, could delay the review and approval of the personal service agreement. Contact
your department’s human resource office for assistance.
Your Department/Institution Name:____________________________________________
Contract Management System (CMS)#:______________Purchase Order #:_____________
Original $ Amount: ________Increase/Decrease in $:_______New Total $ Amount:______
Contractor:_____________________
Sole Proprietor? No
Yes
Assigned Individual Contractor/Leased Worker(s) Name:___________________________
TOTAL TERM OF AGREEMENT (as stipulated in the agreement that includes extensions)
From:_________________
To:________________
1. Please describe the labor and business need for the service being outsourced, including the type of
services being acquired, the specialized skills and expertise required to perform the work, and identify
the direct beneficiary of the services.
2. Have you consulted with the department human resource office to determine the best way to meet
the labor and business need that generated this request?
No
Yes
3. Have these services been purchased through an agreement(s) before?
No
Yes
If yes, for how long?
4. Are these services ongoing for an indefinite period of time?
No
Yes
If yes, for how long?
If yes, please attach the business case and cost analysis that justifies why the service is best
performed either by acquiring FTE or by permanently outsourcing the personal service.
5. Is the individual or contractor a current state employee or has previously been a state employee
either on a temporary or a permanent basis? Has this individual or contractor been used in the past?
No
Yes
If yes, give dates of employment or contract performance dates.
State Temporary Employee
Permanent Employee
Contract Performance Dates
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Parent category: Business