Common use of IN THOSE INSTANCES Clause in Contracts

IN THOSE INSTANCES. This is a written agreement under the compulsory Workers' Compensation laws of the State of Arizona, A.R.S. § 23-901 (et. seq.), and specifically A.R.S. § 23-902 (C), (D), that an independent contractor relationship exists between the parties signed below. The parties agree that the "independent contractor" is independent of the "business" in the execution of the work and not subject to the rule or control of the "business" but is engaged only in the performance of a definite job or piece of work and is subordinate to the "business" only in effecting a result in accordance with that "business" design. The parties also agree that the "business" does not have the authority to supervise or control the actual work of the "independent contractor" or the "independent contractor's" employees. Furthermore, it is understood and agreed that the "independent contractor" or the "independent contractor's" employees are not entitled to workers' compensation benefits from the "business.” The written agreement shall be null and void and create no presumption of an independent contractor relationship if the consent of either party is obtained through misrepresentation, false statements, fraud or intimidation, coercion or duress. WE THE UNDERSIGNED AGREE THAT THE BUSINESS: Does not require the independent contractor to perform work exclusively for the business. This paragraph shall not be construed as conclusive evidence that an individual who performs services primarily or exclusively for another person is an employee of that person. Does not provide the independent contractor with any business registrations or licenses required to perform the specific services set forth in the contract. Does not pay the independent contractor a salary or hourly rate instead of an amount fixed by contract. Will not terminate the independent contractor before the expiration of the contract period, unless the independent contractor breaches the contract or violates the laws of this state. Does not provide tools to the independent contractor. Does not dictate the time of performance. Pays the independent contractor in the name appearing on the written agreement. Will not combine business operations with the person performing the services rather than maintaining these operations separately. INDEPENDENT CONTRACTOR AGREEMENT NAME OF INDEPENDENT CONTRACTOR: ____________________________________________________________ ADDRESS / P.O. BOX: _______________________________________________________ CITY: __________________________________, STATE: ____________ ZIP: __________ SIGNATURE OF INDEPENDENT CONTRACTOR: ______________________________ DATE: ___________ STATE OF ARIZONA AGENCY: _______________________________________________ AGENCY#: ________ ADDRESS: _________________________________________________________________ CITY: __________________________________, STATE: ____________ ZIP: __________ SIGNATURE OF AGENCY CONTRACT ADMINISTRATOR: ______________________________ DATE: ___________ CONTRACT IDENTIFICATION: __________________________________________________ BOTH SIGNATURES MUST BE SIGNED AND THE COMPLETED FORM SUBMITTED TO: ARIZONA DEPARTMENT OF ADMINISTRATION RISK MANAGEMENT DIVISION - INSURANCE UNIT 000 XXXXX 00xx XXXXXX, XXXXX #000 XXXXXXX, XX 00000 An authorized Risk Management Representative will sign your completed form and return it to the agency to be maintained in their records. Signature of Risk Management Authorized Signer Date

IN THOSE INSTANCES. This is a written agreement under the compulsory Workers' Compensation laws of the State of Arizona, A.R.S. § 23-901 (et. seq.), and specifically A.R.S. § 23-902 (C), (D), that an independent contractor relationship exists between the parties signed below. The parties agree that the "independent contractor" is independent of the "business" in the execution of the work and not subject to the rule or control of the "business" but is engaged only in the performance of a definite job or piece of work and is subordinate to the "business" only in effecting a result in accordance with that "business" design. The parties also agree that the "business" does not have the authority to supervise or control the actual work of the "independent contractor" or the "independent contractor's" employees. Furthermore, it is understood and agreed that the "independent contractor" or the "independent contractor's" employees are not entitled to workers' compensation benefits from the "business.” ". The written agreement shall be null and void and create no presumption of an independent contractor relationship if the consent of either party is obtained through misrepresentation, false statements, fraud or intimidation, coercion or duress. WE THE UNDERSIGNED AGREE THAT THE BUSINESS: Does not require the independent contractor to perform work exclusively for the business. This paragraph shall not be construed as conclusive evidence that an individual who performs services primarily or exclusively for another person is an employee of that person. Does not provide the independent contractor with any business registrations or licenses required to perform the specific services set forth in the contract. Does not pay the independent contractor a salary or hourly rate instead of an amount fixed by contract. Will not terminate the independent contractor before the expiration of the contract period, unless the independent contractor breaches the contract or violates the laws of this state. Does not provide tools to the independent contractor. Does not dictate the time of performance. Pays the independent contractor in the name appearing on the written agreement. Will not combine business operations with the person performing the services rather than maintaining these operations separately. INDEPENDENT CONTRACTOR AGREEMENT NAME OF INDEPENDENT CONTRACTOR: ____________________________________________________________ _____________________________________________________________ ADDRESS / P.O. BOX: _______________________________________________________ _______________________________________________________ CITY: ____________________________________________________________________, STATE: ____________ ____________ ZIP: __________ __________ SIGNATURE OF INDEPENDENT CONTRACTOR: ______________________________ _DATE: ___________ ___________ STATE OF ARIZONA AGENCY: _______________________________________________ AGENCY#: ________ # ADDRESS: _________________________________________________________________ CITY: __________________________________, /STATE: ____________ ZIP: __________ SIGNATURE OF AGENCY CONTRACT ADMINISTRATOR: ______________________________ DATE: ___________ ____________ CONTRACT IDENTIFICATION: __________________________________________________ __________________________________________________ BOTH SIGNATURES MUST BE SIGNED AND THE COMPLETED FORM SUBMITTED TO: ARIZONA DEPARTMENT OF ADMINISTRATION RISK MANAGEMENT DIVISION SECTION - INSURANCE UNIT 000 XXXXX 00xx XXXXXX, XXXXX #000 XXXXXXXPHOENIX, XX 00000 AZ 85007 An authorized Risk Management Representative will sign your completed form and return it to the agency to be maintained in their records. Signature of Risk Management Authorized Signer Date

IN THOSE INSTANCES. This is a written agreement under the compulsory Workers' Compensation laws of the State of Arizona, A.R.S. § 23-901 (et. seq.), and specifically A.R.S. § 23-902 (C), (D), that an independent contractor relationship exists between the parties signed below. The parties agree that the "independent contractor" is independent of the "business" in the execution of the work and not subject to the rule or control of the "business" but is engaged only in the performance of a definite job or piece of work and is subordinate to the "business" only in effecting a result in accordance with that "business" design. The parties also agree that the "business" does not have the authority to supervise or control the actual work of the "independent contractor" or the "independent contractor's" employees. Furthermore, it is understood and agreed that the "independent contractor" or the "independent contractor's" employees are not entitled to workers' compensation benefits from the "business.” The written agreement shall be null and void and create no presumption of an independent contractor relationship if the consent of either party is obtained through misrepresentation, false statements, fraud or intimidation, coercion or duress. WE THE UNDERSIGNED AGREE THAT THE BUSINESS: Does not require the independent contractor to perform work exclusively for the business. This paragraph shall not be construed as conclusive evidence that an individual who performs services primarily or exclusively for another person is an employee of that person. Does not provide the independent contractor with any business registrations or licenses required to perform the specific services set forth in the contract. Does not pay the independent contractor a salary or hourly rate instead of an amount fixed by contract. Will not terminate the independent contractor before the expiration of the contract period, unless the independent contractor breaches the contract or violates the laws of this state. Does not provide tools to the independent contractor. Does not dictate the time of performance. Pays the independent contractor in the name appearing on the written agreement. Will not combine business operations with the person performing the services rather than maintaining these operations separately. INDEPENDENT CONTRACTOR AGREEMENT NAME OF INDEPENDENT CONTRACTOR: ____________________________________________________________ ADDRESS / P.O. BOX: _______________________________________________________ CITY: __________________________________, STATE: ____________ ZIP: __________ SIGNATURE OF INDEPENDENT CONTRACTOR: ______________________________ DATE: ___________ STATE OF ARIZONA AGENCY: _______________________________________________ AGENCY#: ________ ADDRESS: _________________________________________________________________ CITY: __________________________________, STATE: ____________ ZIP: __________ SIGNATURE OF AGENCY CONTRACT ADMINISTRATOR: ______________________________ DATE: ___________ CONTRACT IDENTIFICATION: __________________________________________________ BOTH SIGNATURES MUST BE SIGNED AND THE COMPLETED FORM SUBMITTED TO: ARIZONA DEPARTMENT OF ADMINISTRATION RISK MANAGEMENT DIVISION - INSURANCE UNIT 000 XXXXX 00xx XXXXXX, XXXXX #000 XXXXXXX, XX 00000 An authorized Risk Management Representative will sign your completed form and return it to the agency to be maintained in their records. Signature of Risk Management Authorized Signer Date__________________________________________________

IN THOSE INSTANCES. This is a written agreement under the compulsory Workers' Compensation laws of the State of Arizona, A.R.S. § 23-901 (et. seq.), and specifically A.R.S. § 23-902 (C), (D), that an independent contractor relationship exists between the parties signed below. The parties agree that the "independent contractor" is independent of the "business" in the execution of the work and not subject to the rule or control of the "business" but is engaged only in the performance of a definite job or piece of work and is subordinate to the "business" only in effecting a result in accordance with that "business" design. The parties also agree that the "business" does not have the authority to supervise or control the actual work of the "independent contractor" or the "independent contractor's" employees. Furthermore, it is understood and agreed that the "independent contractor" or the "independent contractor's" employees are not entitled to workers' compensation benefits from the "business.” ". The written agreement shall be null and void and create no presumption of an independent contractor relationship if the consent of either party is obtained through misrepresentation, false statements, fraud or intimidation, coercion or duress. WE THE UNDERSIGNED AGREE THAT THE BUSINESS: • Does not require the independent contractor to perform work exclusively for the business. This paragraph shall not be construed as conclusive evidence that an individual who performs services primarily or exclusively for another person is an employee of that person. • Does not provide the independent contractor with any business registrations or licenses required to perform the specific services set forth in the contract. • Does not pay the independent contractor a salary or hourly rate instead of an amount fixed by contract. • Will not terminate the independent contractor before the expiration of the contract period, unless the independent contractor breaches the contract or violates the laws of this state. • Does not provide tools to the independent contractor. • Does not dictate the time of performance. • Pays the independent contractor in the name appearing on the written agreement. • Will not combine business operations with the person performing the services rather than maintaining these operations separately. INDEPENDENT CONTRACTOR AGREEMENT NAME OF INDEPENDENT CONTRACTOR: ____________________________________________________________ FEDERAL ID# OR SOCIALSECURITY: ADDRESS / P.O. BOX: _______________________________________________________ CITY: __________________________________, STATE: ____________ ZIP: __________ SIGNATURE OF INDEPENDENT CONTRACTOR: ______________________________ DATE: ___________ STATE OF ARIZONA AGENCY: _______________________________________________ AGENCY#: ________ # ADDRESS: _________________________________________________________________ CITY: __________________________________, /STATE: ____________ ZIP: __________ SIGNATURE OF AGENCY AGENCY‌ CONTRACT ADMINISTRATOR: ______________________________ DATE: ___________ CONTRACT IDENTIFICATION: __________________________________________________ BOTH SIGNATURES MUST BE SIGNED AND THE COMPLETED FORM SUBMITTED TO: ARIZONA DEPARTMENT OF ADMINISTRATION RISK MANAGEMENT DIVISION SECTION - INSURANCE UNIT 000 XXXXX 00xx XXXXXX, XXXXX #000 XXXXXXXPHOENIX, XX 00000 AZ 85007 An authorized Risk Management Representative will sign your completed form and return it to the agency to be maintained in their records. Signature of Risk Management Authorized Signer Date.

IN THOSE INSTANCES. This is a written agreement under the compulsory Workers' Compensation laws of the State of Arizona, A.R.S. § 23-901 (et. seq.), and specifically A.R.S. § 23-902 (C), (D), that an independent contractor relationship exists between the parties signed below. The parties agree that the "independent contractor" is independent of the "business" in the execution of the work and not subject to the rule or control of the "business" but is engaged only in the performance of a definite job or piece of work and is subordinate to the "business" only in effecting a result in accordance with that "business" design. The parties also agree that the "business" does not have the authority to supervise or control the actual work of the "independent contractor" or the "independent contractor's" employees. Furthermore, it is understood and agreed that the "independent contractor" or the "independent contractor's" employees are not entitled to workers' compensation benefits from the "business.” ". The written agreement shall be null and void and create no presumption of an independent contractor relationship if the consent of either party is obtained through misrepresentation, false statements, fraud or intimidation, coercion or duress. WE THE UNDERSIGNED AGREE THAT THE BUSINESS:  Does not require the independent contractor to perform work exclusively for the business. This paragraph shall not be construed as conclusive evidence that an individual who performs services primarily or exclusively for another person is an employee of that person.  Does not provide the independent contractor with any business registrations or licenses required to perform the specific services set forth in the contract.  Does not pay the independent contractor a salary or hourly rate instead of an amount fixed by contract.  Will not terminate the independent contractor before the expiration of the contract period, unless the independent contractor breaches the contract or violates the laws of this state.  Does not provide tools to the independent contractor.  Does not dictate the time of performance.  Pays the independent contractor in the name appearing on the written agreement.  Will not combine business operations with the person performing the services rather than maintaining these operations separately. INDEPENDENT CONTRACTOR AGREEMENT NAME OF INDEPENDENT CONTRACTOR: ____________________________________________________________ ADDRESS / P.O. BOX: _______________________________________________________ CITY: __________________________________, STATE: ____________ ZIP: __________ SIGNATURE OF INDEPENDENT CONTRACTOR: ______________________________ DATE: ___________ STATE OF ARIZONA AGENCY: _______________________________________________ AGENCY#: ________ # ADDRESS: _________________________________________________________________ CITY: __________________________________, /STATE: ____________ ZIP: __________ SIGNATURE OF AGENCY CONTRACT ADMINISTRATOR: ______________________________ DATE: ___________ CONTRACT IDENTIFICATION: __________________________________________________ BOTH SIGNATURES MUST BE SIGNED AND THE COMPLETED FORM SUBMITTED TO: ARIZONA DEPARTMENT OF ADMINISTRATION RISK MANAGEMENT DIVISION SECTION - INSURANCE UNIT 000 XXXXX 00xx XXXXXX, XXXXX #000 XXXXXXXPHOENIX, XX 00000 AZ 85007 An authorized Risk Management Representative will sign your completed form and return it to the agency to be maintained in their records. Signature of Risk Management Authorized Signer Date.