Common use of INDIVIDUAL CONTRACTOR COMPLETES THIS SECTION AND SIGNS Clause in Contracts

INDIVIDUAL CONTRACTOR COMPLETES THIS SECTION AND SIGNS. Did you retire from one of the State of Washington Retirement Systems? YES NO Did you retire before age 65 using the 2008 early retirement factors (ERF)? YES NO Will you be receiving direct compensation for your services? YES NO Will you be receiving indirect compensation for your services? YES NO CONTRACTOR (Full, individual name of contractor): Signature: Social Security No.: Date:

INDIVIDUAL CONTRACTOR COMPLETES THIS SECTION AND SIGNS. Did you retire from one of the State of Washington Retirement Systems? YES NO Did you retire before age 65 using the 2008 early retirement factors (ERF)? YES NO Will you be receiving direct compensation for your services? YES NO Will you be receiving indirect compensation for your services? YES NO CONTRACTOR (Full, individual name of contractor): Signature: Social Security No.. : Date:

INDIVIDUAL CONTRACTOR COMPLETES THIS SECTION AND SIGNS. Did you retire from one of the State of Washington Retirement Systems? YES NO If ‘YES’, please complete, sign and submit with your signed Agreement; if ‘NO’, please sign and submit with your Agreement: Did you retire before age 65 using the 2008 early retirement factors (ERF)? YES NO Will you be receiving direct compensation for your services? YES NO Will you be receiving indirect compensation for your services? YES NO CONTRACTOR (Full, individual name of contractor): YES NO Signature: Social Security No.. : Date:

INDIVIDUAL CONTRACTOR COMPLETES THIS SECTION AND SIGNS. Did you retire from one of the State of Washington Retirement Systems? YES NO Did you retire before age 65 using the 2008 early retirement factors (ERF)? YES NO Will you be receiving direct compensation for your services? YES NO Will you be receiving indirect compensation for your services? YES NO CONTRACTOR (Full, individual name of contractor): YES NO Signature: Social Security No.. : Date: