Form 2028 - Consultant Or Contractual Service Agreement printable pdf download

CONSULTANT or CONTRACTUAL SERVICE AGREEMENT

RENTON SCHOOL DISTRICT NO. 403

Renton, Washington

Business Office

Contract No. _____________________________

NAME (Payee) ____________________________________

SOC. SEC. No./Taxpayer I.D. No. ___________________________________

(Supplier/Firm/Individual)

REPRESENTATIVE ________________________________

TELEPHONE ___________________________________________________

PAYMENT MAILING ADDRESS _____________________________________________________________________________________________

(street address/PO box no.)

(CITY)

(STATE)

(ZIP CODE)

SERVICES REQUESTED BY ___________________________ BUDGET No. __________________________________________________

(department/building)

By signing below, Supplier agrees to perform specified services for the Renton School District. It is understood that Supplier is not an employee of the District

and such services are exempt from unemployment benefits under RCW 50.04.145.

PURPOSE OF PROJECT: Supplier will provide _______________________(hours/days/task/other) for the purpose of __________________

_________________________________________________________________________________________________________________

DATE: Start date _____________. Completion by _____________. Final decision on number of sessions, time and dates resting with school or department.



Delivery of services not authorized prior to contract approval. (School Board approval required if greater than $5,000)



If amount is $5,000 or greater, submit for School Board approval on Board date: __________________________



Beginning and completion dates are to be within the same fiscal year.

PAYMENT: A fee of $_______________ or an hourly rate of $_______________ per hour plus $____________ for materials and supplies will be paid at

completion of services specified, upon confirmation of requesting school or department. Fees for fewer hours will be adjusted on a prorated basis either by

mutual consent or by District Direction. A maximum payment of $____________________ and/or maximum of _____________ hours is authorized.

GENERAL TERMS AND CONDITIONS:

MATERIALS AND SUPPLIES TO BE PROVIDED BY:

Renton School District _______________ Consultant/Contractor _______________. Materials

purchased or expenses incurred by the Consultant or Contractor without District approval are not reimbursable.

TRAVEL AND PERSONAL EXPENSES – Included in basic fee unless specifically negotiated and itemized below:

_____________________________________________________________________________________________________________________________

COMMENTS____________________________________________________________________________________________

1. Contractors and their employees who will have regularly scheduled unsupervised access to children shall require a record and fingerprint check through the

Washington State Patrol criminal investigation system and through the Federal Bureau of Investigation. RCW28A.400.303.

2. Contractors shall prohibit any employee who has contact with children during the course of employment and who has plead guilty or been convicted of any

felony crime as set forth in RCW.28A.400.330 from working at a public school.

Certification of Supplier/Consultant – Under penalties of perjury, my signature below certifies:

(1)

The number shown on this form is my correct taxpayer identification number;

(2)

I am not subject to backup withholding;

(3)

I have not been an employee of the Renton School District in the last 12 calendar months.

(4)

I will complete the “Contractor Status” form and attach to this Agreement.

(5)

I have complied with all of the above requirements. Failure to comply shall be grounds for immediate termination of this contract.

The Renton School District complies with all state and federal rules and regulations and does not discriminate on the basis of race, color, national origin, sex or

handicap.

H. Supplier/Consultant __________________________________________________________

Date _____________________________

Principal/Supervisor __________________________________________________________

Date______________________________

Supervisor/Dept. of Instruction __________________________________________________

Date______________________________

K. Business Operations _________________________________________________________

Date ______________________________

L. Human Resources Department _________________________________________________

Date______________________________

M. Board Approval ______________________________________________________________