Independent Contractor (Ic) Checklist Page 9
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10Independent Contractor
Confirmation of Services Performed
(or Cancellation of Services)
for Single Payments
Independent Contractor Name:
Date(s) of Service(s):
to
Grand Total from Request for
Payment Form:
FOR SINGLE PAYMENTS ONLY:
This memo is to confirm that the above mentioned Independent Contractor has met the terms
of his/her contract. Payment may now be made and released to this Independent Contractor.
OR
Services were not provided. Do not pay this Independent Contractor and void the Request
for Payment.
Signature of department representative (does not need signature authority)
Printed Name
✍
Signature
Date
Submit all Confirmation of Services Performed Forms to CSUSM Accounts Payable:
Fax: 760-750-3286
Email:
icconfirmation@csusm.edu
Hand-deliver: Accounts Payable in Craven 4600
Revised:
0 2/23/10
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Parent category: Business