ࡱ>   bjbjVV <<)k 4hiE@n$$$$A(/,<k. V?X?X?X?X?X?X?ADX?7'@(@77X?$$E@===7R$YR$V?=7V?===7"">$Вހw 8>B?[@0@ >AE86AE>>AE&>/D1=m3L4///X?X?<///@7777AE///////// :  This agreement, dated  FORMTEXT       is entered into between The University of Akron, a state of Ohio educational institution in Akron, Ohio (hereafter referred to as the UNIVERSITY) and  FORMTEXT First Name  FORMTEXT Last Name/ FORMTEXT Company Name, an independent contractor located at  FORMTEXT Address,  FORMTEXT City,  FORMTEXT STATE  FORMTEXT Zip Code (hereafter referred to as the CONTRACTOR). CONTRACTOR represents that its professional credentials are such that it can provide the expert assistance and other services ( FORMTEXT services to be provided) as described in its original proposal dated  FORMTEXT       attached hereto as Exhibit A and made a part hereof. However, any terms and conditions listed in Exhibit A are not made part of this agreement. In consideration of mutual covenants and promises between the parties, it is hereby agreed as follows: 1. CONTRACTOR agrees to perform as specified, essentially charging the UNIVERSITY for expert assistance and other services as described in Exhibit A. CONTRACTOR warrants that it shall at all times during the performance of this agreement, provide its best professional efforts. UNIVERSITY, in consideration of these services, agrees to pay  FORMTEXT spelled out cost dollars ($ FORMTEXT      ) upon proper invoice submitted to: The University of Akron Accounts Payable 302 Buchtel Common Akron, Ohio 44325-6214 Any additional work, necessitating additional charges by CONTRACTOR, may be contracted only upon mutual assent which is evidenced by a Change Notice to the Purchase Order. 2. UNIVERSITY will pay the amount set forth in item #1 above by UNIVERSITY check made payable and mailed to:  FORMTEXT First Name  FORMTEXT Last Name/ FORMTEXT Company Name  FORMTEXT Address  FORMTEXT City,  FORMTEXT STATE  FORMTEXT Zip Code Social Security or Federal Tax I.D. Number  FORMTEXT SS # or Tax ID Contact person for UNIVERSITY is:  FORMTEXT U Of A Contact Name  FORMTEXT U Of A Contact Office/Department (330) 972- FORMTEXT U of A Contact/Department Extension Cancellation: Either party may cancel this agreement if either party is unable to fulfill the terms hereof due to an act of God or any other legitimate conditions beyond the control of the parties. Disclaimers: UNIVERSITY will not be liable for the following expenses and costs, it being agreed that CONTRACTOR shall pay for all those items listed below: a. Union dues or other expenses; b. Federal, State, or Local Taxes; c. Agents commissions or other expenses or obligations; d. Damages to CONTRACTOR's equipment or materials; e. Compensation for any lost or stolen equipment or materials whatsoever; f. Workers compensation or other insurance; and g. Any expenses not approved by UNIVERSITY. CONTRACTOR agrees to indemnify and hold UNIVERSITY harmless from all such costs and liabilities arising out of the services performed under this agreement. Modification: Either party may modify this agreement only with the prior written consent of the other party hereto. 7. CONTRACTORS work under this agreement is a "work for hire" for purposes of the copyright laws of the United States and any foreign countries, and title to any subject copyright will vest with the UNIVERSITY. 8. Notices: Any notice required under this agreement shall be in writing and may either be given by personal delivery or sent by regular mail addressed to the following: As to UNIVERSITY: The University of Akron Department of Purchasing Attention: Valoree Lee 302 Buchtel Common Akron, Ohio 44325-9001 As to CONTRACTOR:  FORMTEXT First Name  FORMTEXT Last Name/ FORMTEXT Company Name  FORMTEXT Address  FORMTEXT City,  FORMTEXT STATE  FORMTEXT Zip Code Notice shall be deemed to be received upon presentment to the other party or upon three (3) days after mailing, if mailed postage prepaid by regular mail at the address set forth above for the respective party or at such changed address as may be subsequently submitted by written notice of either party. 9. Choice of Law: The laws of the state of Ohio shall be used to govern and construe the terms of this agreement. Chapter 2743 of the Ohio Revised Code shall govern UNIVERSITY's liability arising out of or under this agreement. 10. Integration: This document and the referenced Purchase Order represent the entire agreement between the UNIVERSITY and CONTRACTOR. 11. Execution: This agreement must be executed by CONTRACTOR and UNIVERSITY as a condition of CONTRACTOR receiving any payment hereunder or arising out of this agreement. The University of AkronContractorBy:By: Name: Andrew Roth Title: Director of PurchasingName:  FORMTEXT       Title:  FORMTEXT      Date:  FORMTEXT      Date:  FORMTEXT      Telephone: (330) 972-7340Telephone:  FORMTEXT       (PSA010203) date \@ "MMMM d, yyyy"October 29, 2010  FORMTEXT First Name  FORMTEXT Last Name  FORMTEXT Company Name  FORMTEXT Address  FORMTEXT City,  FORMTEXT STATE  FORMTEXT Zip Code Subject: Professional Services Agreement Dear  FORMTEXT First Name  FORMTEXT Last Name, I have enclosed two copies of the University's Professional Services Agreement regarding  FORMTEXT Service to be provided services as discussed with  FORMTEXT U Of A Contact Name for your review, acceptance and signature. Please review this agreement and if acceptable sign both copies and return them to my attention at the following address: The University of Akron  FORMTEXT U Of A Contact Office/Department 302 Buchtel Common Akron, Ohio 44325- FORMTEXT Dept. Zip ATTN:  FORMTEXT U Of A Contact Name One copy of the fully executed agreement will be sent to you along with a University purchase order (for payment purposes, see paragraph 10.) upon approval of the Universitys Director of Purchasing. Please call me if you have any questions. Sincerely,  FORMTEXT U Of A Contact Name  FORMTEXT U Of A Contact's Title VENDOR AFFIDAVITSTATE OF FORMTEXT      COUNTY OF FORMTEXT      I, authorized person for  FORMTEXT      , do hereby state and affirm that neither I nor any agents of the above-named company nor any other party acting on companys behalf have paid or agreed to pay directly or indirectly any person, firm, or corporations any money or valuable consideration for assistance in securing this agreement for the following:  FORMTEXT      . I further agree that no such money or reward will be hereafter paid. Do any University of Akron employees, or their family members, have a financial interest in the organization submitting the agreement?  FORMCHECKBOX Yes FORMCHECKBOX NoIf so, please attach a statement giving details.Does the affiant have any relative/family members employed by The University of Akron? FORMCHECKBOX  Yes  FORMCHECKBOX  No If so, please identify the employee and relationship.Employee Name  FORMTEXT       Relationship  FORMTEXT      Further Affiant sayeth naught.AffiantSworn to and subscribed in my presence this  FORMTEXT       day of  FORMTEXT      , 20 FORMTEXT      .Notary Public  THE UNIVERSITY OF AKRON INDEPENDENT CONTRACTOR CHECKLISTName of proposed independent contractor: FORMTEXT      Departmental Requisition Number: FORMTEXT      1. Items to be completed by the Independent Contractor:a. I provide similar services to other clients and/or businesses.YES  FORMCHECKBOX NO  FORMCHECKBOX b. I engage in entrepreneurial activities in an established trade, occupation or business and am at risk for profit or loss.YES  FORMCHECKBOX NO  FORMCHECKBOX c. I am a current or past employee of The University of Akron. 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CJOJQJU^J0000}}$$e&`#$/Ifa$gd%glkd<$$Ifl4,"" 6`e064 laf4000 0pp$e&`#$/Ifgd! |kd'=$$Ifl0,"LL 6`e064 la 0"0B0F0m[$e&`#$/Ifgd! $$e&`#$/Ifa$gd! |kd=$$Ifl0,"LL 6`e064 laF0H0J0L0pp$e&`#$/Ifgd! |kdw>$$Ifl0,"LL 6`e064 laL0N0P0R0T0V0X0Z0\0^0sUUUUUUU / P X !(#$%gd$ 0d*$a$|kd?$$Ifl0,"LL 6`e064 la ^0`0b0d0f000,1kX%$$M&`#$/Ifa$gd@hkd?$$Ifl*+ t0644 layt@ $Ifgd! gd!  / P X !(#$%gd.1B1D1F1P1R1T1V1X1Z111111111122 2j2k2y2z2{2222˳{˳oZ)jzDh@h15CJU\aJh@h! CJ\aJ)j3{3~34 !"ʸʒ}ʸqcacL)jBHh@h15CJU\aJUh@h! 6CJ\aJh@h! CJ\aJ)jFh@h15CJU\aJ)j^Fh@h15CJU\aJ h@h! CJOJQJ^JaJ#h@h! CJOJQJ\^JaJh@h! 5CJ\aJ#jh@h! 5CJU\aJ)jDh@h15CJU\aJ233'3(3=3%$$M&`#$/Ifa$gd@%$$M&`#$/Ifa$gd@D$ Ph8p @ xHP X !(#$%h$M&`#$/If^h`a$gd@=3>3A&%$h$M&`#$/If^h`a$gd@kdFG$$IflrlX X$D%0* t 6`M0*644 layt@ies.)YES  FORMCHECKBOX NO  FORMCHECKBOX d. I will maintain worker's compensation coverage or will present proof of exemption as a sole proprietor.YES  FORMCHECKBOX NO  FORMCHECKBOX e. I agree that The University of Akron will withhold no taxes from thepayments made to me and I will be solely responsible for payment of local, state, and federal taxes.YES  FORMCHECKBOX NO  FORMCHECKBOX f. I agree that I will be paid by the job, will furnish all tolls andmaterials needed to do the contemplated work, and will pay for all of my own business expenses.YES  FORMCHECKBOX NO  FORMCHECKBOX Items to be completed by the University Department wishing to use the services of this Independent Contractor:2. The individual to perform the services:a. Will receive little or no training, supervision, or instruction from University personnel, other than conveying the scope of service desired.YES  FORMCHECKBOX NO  FORMCHECKBOX b. Will be responsible for determining the means and methods to use to perform the requested services.YES  FORMCHECKBOX NO  FORMCHECKBOX c. Will provide his/her own supplies, equipment, forms, etc., necessary to perform services, and the cost of these is included in rate or total fee.YES  FORMCHECKBOX NO  FORMCHECKBOX d. Will set his/her own priorities on time, amount of effort, and hours of work, to accomplish services within stated time frame.YES  FORMCHECKBOX NO  FORMCHECKBOX e. Is not providing services similar to those currently being provided by any University employee(s).YES  FORMCHECKBOX NO  FORMCHECKBOX f. Will be paid on the basis of a completed project, progress payments or in a manner consistent with others in the same trade, occupation, profession or business.YES  FORMCHECKBOX NO  FORMCHECKBOX Either party must provide a detailed explanation of any questions that were answered "No", with the exception of 1. c.I certify that to the best of my knowledge the above is correct. FORMTEXT      Independent Contractor s SignatureDate FORMTEXT      Authorized University Departmental Supervisor s SignatureDate Note: This form must be signed by the department chair or his/her designee. Please return to the Department of Purchasing, + 9001 with the completed Professional Services Agreement.    Professional Services Agreement Page  PAGE 1  Professional Services Agreement Department of Purchasing Akron, OH 44325-9001 (330)972-7340 Office (330)972-5564 Fax Department of Purchasing Akron, OH 44325-9001 (330)972-7340 Office (330)972-5564 Fax 3%$$M&`#$/Ifa$gd@%$$M&`#$/Ifa$gd@"01234{RXYoZ)jLh@h15CJU\aJ)jLh@h15CJU\aJh@h! 5CJaJ)jJh@h15CJU\aJ)j&Jh@h15CJU\aJ h@h! 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