Test Today USA LLC NC Independent Contractor Agreement
Applicant Complete the Following
1. In connection with my Independent Agent Agreement, I understand that an investigative consumer report may be requested that will include information as to my character, work habits, performance, and experience, along with reasons for termination of past employment. I understand that as directed by company policy and consistent with the job described, you may be requesting information from public and private sources about my: workers' compensation injuries, driving record, court record, education, credentials, credit, and references.
2. Medical and workers' compensation information will only be requested in compliance with the Federal Americans with Disabilities Act (ADA) and/or any other applicable state laws. According to the Fair Credit Reporting Act, I am entitled to know if contract is not accepted because of information obtained by the contracting company from a consumer-reporting agency. If so, I will be notified and given the name and address of the agency or the source which provided the information.
3. I acknowledge that a facsimile (FAX) or photographic copy shall be as valid as the original. This release is valid all most federal, state and county agencies including all state Departments of Labor.
4. If you want a copy of the report(s) ordered, check this box.
5. I hereby authorize, without reservation, any law enforcement agency, institution, information service bureau, school, employer, reference or insurance company contacted by the reporting agency or its agent, to furnish the information described in Section 1. The following information is required by law enforcement agencies and other entities for positive identification purposes when checking public records. It is confidential and will not be used for any other purposes. I hereby release the contracting company and agents and all person, agencies, and entities providing information or reports about me from any and all liability arising out of the requests for or release of any of the above mentioned information or reports.
6. I acknowledge that the foregoing authorization shall continue in force until revoked by me in writing.
Please print your full name
Please print other names you have used
Social Security Number
Date of Birth
The Following states require sex and race to obtain information: AL, AR, FL, GA, IA, IN, OR, TX, WI.
State ID/Driver’s License Number & State Issuing License
Name as it appears on License
Independent Contractor Agreement
This is an Independent Contractor Agreement (“Agreement”) between “Trinity Grand Marketing, LLC, DBA: Test Today USA.”, (the “Company”) and the individual named above to (referred as "Contractor",“Independent Representative”, “Independent Contractor”, “IC” “IBO” or “the Rep”).
The parties agree as follows:
(INSERT HERE BASED ON POSITION)
DESCRIPTION OF SERVICES
Termination of Agreement. Company may discontinue the services of this Agreement upon written or verbal notice under the following conditions:
(a) Nonperformance by the Contractor/ Direct Seller.
(b) Contractor commits a material breach of the Agreement.
(c) The conviction of Contractor of any crime.
(d) Contractor files any false or forged document with the Company or Customers.
Contractor may discontinue the services of this Agreement upon written or verbal notice under the following conditions:
(a) Company commits a material breach of the Agreement.
(b) Company fails to pay any valid invoice within 30 days of receipt from customer.
This Agreement may also be terminated upon the mutual, written or verbal agreement of the parties at any time.
Customer Complaints. In the event the Contractor causes an error, customer and/or potential customer complaint, including but not limited to Fraudulent Solicitation, or a complaint by the Public Utility Commission, that results in any damages (“Damages”), including, but not limited to, fees, charges, penalties, fines, or costs incurred by the Company, customer and/ or potential customer, Contractor shall reimburse the Company and customer and/ or potential customer for such Damages upon presentation of an invoice or as a credit to be made against Contractor’s compensation for services described in the Contract. The prior sentence shall survive after the termination or expiration of the Agreement.
COVID 19 qPCR Testing
National Consultant (NC) Independent Business Organization (IBO) Territory: United States
(A completed IBO App ICA COVID Waiver W9 ACH Bank Deposit must be executed on file before services commence) (Each IBO will be required to submit invoices for pay periods based on lab reporting) (Each IBO will complete certifications including but not limited to HIPPA, Insurance Card, CMA or higher and campaign training course)
Marketing Metric Service Fee (MSF): Encompasses all parties roles in the process.
Equates to any lawful act done under the scope of business defined in this agreement in it's entirety by which Contractors shall strive to maintain compliance, protocol, and procedures in relation sequential steps in processing intakes, collection of specimens, inventory, daily drop shipping, set up take down as required, establishing site locations or appointments, sourcing additional staff, inspection of sites an insure accurate collection, patient safety, privacy, without limitation are held to the highest standards possible set forth during certification.
MICRO-SITE: Mobile appointment or non-static locations typically with 2 CS and 1 CO that average 800-1,200 monthly tests.
HUB: Any large venue where Corporate had a direct involvement in securing the landowner permission to use as a CDC testing site. This does not apply to micro-sites or any locations where the NC, RD or CO secures the permission form that average 8,000 monthly tests.
IBO WEEKLY PLAN: Contractor (CS, CMA, CNA, LNA, RN ETC.) shall perform the services specified in ICA at any place or location determined by Contractor at will, voluntarily at their own discretion upon submitting a planned weekly schedule in advance to their CO, NC, or Company. FAILING TO NOT HONOR YOUR PERSONALLY SELECTED SCHEDULE MAY LEAD TO IBO'S DISCONTINUATION OF SERVICES .
PAY CYCLE: Based on Monday-Sunday accepted lab reporting which thus far has been 95-98% deemed accepted, draws will be disbursed 3 weeks in arrears. Intakes received by lab 1/18-1/24 would issue 50% draws during week beginning 2/15 and then trued up on 3/1.
SERVICE PRODUCTION: To continue providing services under this agreement relating to performance, NCs teams are expected to produce at least 2000 tests for each Monday through Sunday period. From time to time, Company will assit contractor in providing exclusive site locations as well as informing the local community to increase traffice to those sites.
Team Oversight Fee (TOF): $1.00 or $2.00 per/accepted test by CSA/CS/CO Tests/Hr+MMSF =TOF
($1.00 applies only to company secured testing sites)
Example 1. 20 CS, CSAs , Cos, complete 8,000 Tests monthly =$8,000-$16,000 TOF
Compensation: INTAKES NOT INCLUDING A SOCIAL SECURITY NO. INCREASE BACK OFFICE SUPPORT AND DELAY PAYMENT FROM CLIENT. Patient Social Security No. are not required to be tested.
As sole compensation under this Agreement, Contractor shall be entitled to receive a Marketing Metric Service Fee for providing consulting services related to intakes accepted by the Laboratory as billable for services performed by Contractor for the benefits of Company. Weekly reporting will be provided to Company, from previous week’s approved samples Monday thru Sunday. There are no exceptions, where Company is required to pay compensation to Contractor, if Company does not receive payments from Laboratory for services rendered. Once Company receives payment then lump sum balances will be paid less recoverable draws and/or supplies against compensation. Compensation will be paid on the 5th and 20th of each month.
* Unaccepted Intakes: Any and all mistakes with patient intakes, that can be avoid by the contractor, (spelling errors, transposing numbers, populating fields with inaccurate information) beyond the first 15 intakes by any independent contractor, IBO will result in no earned compensation. QC Dept. has time to support Collection Specialist for their first 15 intakes and therefore should be adequately versed and up to speed on processes and requirements for this position to do it correctly. Less than a 2% correction rate is acceptable. Examples below can cause a potential chargeback if previously paid a draw: Spelling or typos errors on general data entry that are not deemed correctable by Clinic will not be payable. Insurance Entry mistakes; populating information into the wrong fields on intake or taking unacceptable insurance cards (ie: RX card, etc…) If patient has insurance, Collection Specialist cannot select NO Insurance, period. Non-legible uploads of DL and/or Insurance cards, when presented with Insurance. Delays on outbound shipping; when sending off patent samples to Laboratory No Later than next following day. Always prefer same day 24 hours shipping, when absolutely possible. Beyond 24 hours from Collection of Sample, shipments, unless weekends, can and/or will result in termination of agreement if egregiously careless delay is identified by the Laboratory upon receipt. Not collecting enough Saliva (5ml) to properly conduct test and provide the results. Properly communicating with patient what we need to provide the most accurate test
Indemnification From Liability; Contractor shall indemnify and hold Company harmless from and against any and all claims, causes of action, complaints, damages, penalties, costs and expenses (including attorney's fees and other legal expenses) arising directly or indirectly from any act or failure of Contractor or his or her assistants or employees arising out of or resulting from services performed under or in connection with this Agreement, including all claims relating to the injury, disability or death of any person or damage to any property.
Punishment shall be enforced to the extent of the State and Federal laws for any wrongdoing with a zero tolerance policy for any misconduct relating to malpractice.
COMPANY., POLICY PROHIBITING SEXUAL HARASSMENT
Statement of Philosophy
COMPANY. (herein after referred to as COMPANY) is proud of its tradition of a collegial work environment in which all individuals are treated with respect and dignity, including clients, customers, employees, vendors, and independent contractors. Each individual has the right to work in a professional atmosphere which promotes equal employment opportunities and prohibits discriminatory practices, including sexual harassment. At COMPANY, sexual harassment, whether verbal, physical, or environmental, is unacceptable and will not be tolerated.
Definition of Sexual Harassment
The U.S. Equal Employment Opportunity Commission Guidelines on Discrimination Because of Sex (29 C.F.R. §1604.11(a)) defines conduct which constitutes prohibited sexual harassment. Section 1604.11(a) provides that unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when:
Examples of sexual harassment include, but are not limited to:
Individuals Covered Under the Policy
This policy covers all individuals in the workplace. COMPANY will not tolerate, condone, or allow sexual harassment, whether by fellow employees, supervisors, managers, customers or other nonemployees who conduct business with this Company. COMPANY encourages the reporting of all incidents of sexual harassment, regardless of who the offender may be, or the nature of the offender's relationship to the Company.
Reporting the Complaint
While COMPANY encourages individuals who believe they are being harassed to firmly and promptly notify the offender that his or her behavior is unwelcome, the Company also recognizes that power and status disparities between an alleged harasser and a target may make such a confrontation impossible. In the event that such informal, direct communication between individuals is either ineffective or impossible, the following steps should be taken in reporting a sexual harassment complaint:
Individuals who believe they have been sexually harassed should report the incident to all the following individuals:
1) Frederick Costa III / President, C.E.O. of COMPANY / Call (424) 233-5996 and mail to [email protected]
2) Darwin Troupe / Outside Consultant for COMPANY / Call (310) 910-6645 and email to [email protected]
If the complaint is successfully resolved in an informal manner, to the complainant's satisfaction, Fred Costa shall file a confidential report about the complaint and its resolution, so that the company will be aware of any pattern of harassment by a particular individual, and also will be aware of all complaints of sexual harassment on a company-wide basis. If the complaint is not successfully resolved in an informal manner, a written report shall be made to Fred Costa.
An accurate record of objectionable behavior or misconduct is needed to resolve a formal complaint of sexual harassment. Verbal reports of sexual harassment must be reduced to writing by either the complainant or Fred Costa and be signed by the complainant. Individuals who believe they have been or currently are being harassed should maintain a record of objectionable conduct in order to prepare effectively to make their written report and to substantiate their allegations. While COMPANY encourages individuals to keep written notes in order to accurately record offensive conduct or behavior, COMPANY hereby notifies all employees that in the event a lawsuit develops from the reported incident, the complainant's written notes may not be considered privileged or confidential information.
COMPANY encourages a prompt reporting of complaints so that a rapid response and appropriate action may be taken. A prompt report not only aids the complainant, but also helps to maintain an environment free from discrimination for all employees.
Investigating the Complaint
Any allegation of sexual harassment brought to the attention of the following individuals:
2) Darwin Troupe / Outside Consultant for COMPANY / Call (310) 910-6645 and email to [email protected]
, will be promptly investig dated. Confidentiality will be maintained throughout the investigatory process, to the extent practical and appropriate under the circumstances.
The investigator will try to take the wishes of the complainant under consideration, but will thoroughly investigate the matter, keeping the complainant informed as to the status of the investigation.
Resolving the Complaint
In order to minimize the damage to COMPANY’s, the complainant, and the alleged harasser, Fred Costa will complete the investigation of a sexual harassment complaint, and communicate his or her findings and intended response to the complainant and alleged harasser, as expeditiously as possible. If COMPANY finds that harassment occurred, the harasser will be subject to appropriate disciplinary action, as listed below (see §VII). The complainant will be informed of the disciplinary action taken. If COMPANY determines that no sexual harassment has occurred, this finding will be communicated to the complainant and to the alleged harasser. If COMPANY cannot determine whether or not sexual harassment occurred, this finding will be communicated to the complainant and to the alleged harasser, and the matter will be recorded as unresolved. In any event, both the complainant and the alleged harasser will be informed again of the procedures set forth in this sexual harassment prevention policy.
Individuals found to have engaged in misconduct constituting sexual harassment will be subject to appropriate discipline, up to and including discharge and/or termination of services to COMPANY. In addressing incidents of sexual harassment, COMPANY’s response will include, at a minimum, reprimanding the offender and preparing a written record. Additional action may include: referral to counseling, withholding of a promotion, reassignment, and temporary suspension without pay, financial penalties, termination employment, or termination of services to COMPANY. This policy is designed to protect all employees and non employees providing services to COMPANY from harassment in any way associated with the workplace or work environment, regardless of the identity or status of the harasser. Although COMPANY’s ability to discipline a non-employee harasser (e.g., a customer or supplier or independent contractor) may be limited by the degree of control, if any, that it has over the alleged harasser, any employee or non-employee who has been subjected to sexual harassment should file a complaint and be assured that action will be taken. Such action may include closing business with a customer, reporting a supplier to his or her employer, reporting a public official to an appropriate agency, or any other appropriate action to protect the employees and non-employees of COMPANY.
Protection Against Retaliation
COMPANY will not in any way retaliate against an individual who makes a complaint of sexual harassment or against any participant in the investigation, nor will it permit any supervisor/manager or employee or non-employee providing a service to COMPANY to do so. Retaliation is a serious violation of this sexual harassment policy and should be reported immediately. Any person found to have retaliated against another individual for reporting sexual harassment will be subject to the same disciplinary action described above (see §VII). An individual who makes an intentional or reckless false complaint also will be subject to the same disciplinary action as described above (see §VII).
The industry that COMPANY operates in and the nature of COMPANY’s business requires COMPANY to use the services of independent contractors and other non-employee service providers. Although COMPANY has little control over the actual work environment in which independent contractors and other non-employee service providers render services to the company, independent contractors and non-employee may meet and work together as a result of their relationship with COMPANY. As such, COMPANY may require its independent contractors and non-employee service providers to sign its Policy Prohibiting Sexual Harassment. The act of an independent contractor or non-employee service provider signing this Policy does not change the relationship of the independent contractor or non-employee service provider signing to the status of an employee. An independent contractor or non-employee service provider signing this Policy acknowledges and agree that his or her act of signing this Policy does not constitute and employer and employee relationship between COMPANY and independent contractor or non-employee service provider.
COMPANY has developed this policy to ensure that all its employees and non-employee providing as service to COMPANY work in an environment free from sexual harassment. The Company will make every effort to ensure that all its personnel are familiar with the policy and know that any complaint received will be thoroughly investigated and appropriately resolved.
INDEPENDENT CONTRACTOR COMPLIANCE PROCESSING/ADMINISTRATION / EQUIPMENT WAIVER
I authorize “COMPANY.” to deduct $10.00 for Covid Testing, $50.00 for Energy/Wireless contracts and $100.00 for Cable/Telecom contracts "from any payable commissions owed to me". This may be done in 3, payments depending on my request and amount applicable for contract.
I understand this one time deduction is used solely to process, background checks, drug lab testing, DMV driving records, uniforms, jackets, apparel, and ID badges. For our Client’s security a $100.00 fee may be accessed for each lost, stolen, or non- returned issued ID Badge. Should the Agent not turn in ID within 10 days upon termination, $100.00 will be deducted from final commissions or reserve balance available.
If the office location or project campaign I am working involves an office administrator to complete or submit any required paperwork or data entry tasks related company being able to properly invoice client for my services provided, I agree to the following deduction out of each commission check owed to me. $10.00
Some of COMPANY’s contracts will require contractors to use or collect equipment in the normal course of conducting business. If I am issued any of the following equipment/devices and the items are stolen or never returned the following amounts will be applied to any commissions or balance available in my reserve account. Using your own Android or Iphone device is acceptable.
Digital Converter: $500.00 (if not returned after issued by company or collected from customer)
Cellular Phone: $35.00 per/device (related to inventory associated with ETC wireless contracts)
Tablet Device or 4G Phone plus accessories: $150.00 (used to process orders) (paid in 5 installments)
Monthly Data Services: $25.00 (if paid by company)
Scrubs: Supplied by Contractor for COVID testing
In order to maintain compliance with COMPANY clients, all items issued, except those specifically paid for by contractor must be returned to local office or COMPANY leader including but not limited to all branded materials and work orders.
REPRESENTATIVE CODE OF CONDUCT PLEDGE AND SALES STANDARDS
I, the undersigned, fully understand the responsibility I am about to undertake as an independent contractor selling the services of COMPANY to the general public. While I am ultimately responsible for the results of my sales efforts, COMPANY has certain basic requirements that guide my professional behavior. I understand them to be as follows:
In these Sales Standards the term “customer” includes both prospective and existing COMPANY PARTNERS’ customers. “Agent” means the person, who is employed by, or an independent agent of COMPANY and who is or will be licensed by COMPANY PARTNERS to sell COMPANY PARTNERS products and services. COMPANY is ultimately responsible for Agent’s compliance with these Sales Standards.1. Agents must, at all times, prominently display their COMPANY PARTNERS issued Agent identification badge. This badge will include the Agent’s name and photograph.
Conduct themselves with integrity and honesty.
Be polite and courteous with customers, other agents, COMPANY PARTNERS employees, and any other members of the public at large. On behalf of COMPANY
PARTNERS, Agents will always thank an COMPANY PARTNERS customer for their time and/or business.Immediately report any incident to their supervisor involving the police/law enforcement or any situationthat could have potential brand/reputational risk to COMPANY PARTNERS.Immediately cease using any outdated COMPANY PARTNERS contract forms or other sales materials upon notification by COMPANY PARTNERS, and will immediately return all outdated unusedforms or materials to COMPANY PARTNERS.Truthfully provide accurate and verifiable comparisons, as well as honest answers to all questions.Allot customer a sufficient amount of time to read though all documents provided.Clearly explain why they are requesting the customer’s bill and make sure the customer understands the reason for this request.Present all the facts needed to make an informed decision.Clearly explain that the price they are quoting only covers the Generation and, in some cases, Transmission. Customer will continue to pay the local utility for the distribution portion of their bill.Advise a customer of their cancellation rights by referring the customer to the applicable section of the contract.Only use sales material approved by COMPANY PARTNERS management.a. All approved sales material must be read and understood by Agent before use.b. Agents will follow any standard sales presentation scripts provided in writing by COMPANYPARTNERSGive the customer a copy of any documents that were signed, including, but not limited to, the sales contract.Submit completed paperwork to Service Provider’s office within 24 hours of a completed sale, or as soon thereafter as is reasonably possible.Successfully complete COMPANY PARTNERS’s agent training and certification process for general industry knowledge, legal and regulatory requirements including these Sales Standards, and any COMPANY PARTNERS products and services before marketing any such products or services. COMPANY PARTNERS requires all Agents to attend ongoing training sessions provided by either COMPANY PARTNERS or Service Provider.Be responsible for obtaining and maintaining knowledge of COMPANY PARTNERS’s products and services, and the general market conditions for those products and services as provided by COMPANY PARTNERS in writing, so that inquiries by customers or prospective customers can be responded to appropriately and completely. Be dressed professionally (business casual) while selling on behalf of COMPANY PARTNERS.4. Agent will NOT:Harass customers in any way.Exert undue pressure on a customer, especially while customer is reading through provided documents.Make any false or misleading statements, or give any false answers, which are likely to mislead a customer with regard to any term in COMPANY PARTNERS’s offer.Use a customer’s cancellation rights as a sales tactic by urging a customer to sign now because they can cancel later, or in any other way.Make any false or malicious statements regarding COMPANY PARTNERS and its Affiliates or employees, or other Agents, or regarding any of COMPANY PARTNERS’s competitors or other industryparticipants.Copy, release, disclose, or use (other than appropriate use in the course of selling on behalf of COMPANY PARTNERS and in accordance with these Sales Standards) confidential or proprietary information, or trade secrets, of COMPANY PARTNERS and its Affiliates or information provided to Agents by COMPANY PARTNERS in respect of customers.Discriminate in the selection of individual or groups of prospective customers to solicit on the basis of race, color, religion, national origin, sex, age, sexual orientation, gender identity and expression, disability, marital status and any other bases under federal, state or local laws.Be permitted to wear any of the following types of clothing while selling on behalf of COMPANY PARTNERSa. Sandals, flip flops, or open-toed shoesb. Shortsc. Blue jeansd. Baseball caps or headbands, with the exception of COMPANY PARTNERS branded capse. Excessively loose or baggy clothingf. Low fitting or tight fitting clothingg. Visible tattoosh. Conspicuous piercingsi. Unnatural hair colorj. Any other non-approved clothing5. The breach of any civil or criminal law by an Agent, whether committed against a member of thepublic at large, another Agent, or an COMPANY PARTNERS employee, will be grounds forimmediate termination of Agent’s license.Forgery is a crime. Suspicion of forgery will result in suspension of an Agent’s license during investigation. Any Agent found to be guilty of forgery will have their license terminated immediately, any monies otherwise owing to the Agent will be withheld, and the Agent will be prosecuted to the full extent of the law.Harassment of an Agent by a customer, or anyone else, is also a crime, and should be reported promptly to COMPANY PARTNERS so that COMPANY PARTNERS can take all appropriate action to protect the rights of its Agents.
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS (ACH CREDITS)
Trinity Grand Marketing LLC.
I (we) hereby authorize Trinity Grand Marketing LLC. hereinafter called COMPANY, to initiate credit and, if necessary, debit entries and adjustments for any credit entries in error to my (our): (select one) Account type: indicated below, at the depository Financial Institution named below, and to credit or debit the same from such account. I (we) acknowledge that the authority will remain in effect until I have (or either of us) cancelled it in writing and that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.
This authorization is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time, and in such manner as to afford COMPANY and
Financial Institution a reasonable opportunity to act on it.
Pursuant to Internal Revenue Service Regulations, you must furnish your Taxpayer Identification Number (TIN) to Trinity Grand Marketing LLC. If this number is not provided, you may be subject to a 31% withholding on each payment. To avoid this 31% withholding and to insure that accurate tax information is reported to the Internal Revenue Service, please use this form to provide the requested information.
PRIVACY ACT STATEMENT
Section 6109 of the Internal Revenue Code requires you to give your correct Taxpayer Identification Number (TIN) to persons who must file information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. The IRS will use the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation and to cities, states, and the District of Columbia to carry out their tax laws. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 30% of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply
Purpose of this form:
Trinity Grand Marketing LLC is processing a payment. To conform to IRS regulations for Form 1099, we must have a Federal Tax Identification Number or Social Security Number in our files for ALL VENDORS and INDIVIDUALS receiving payments from Trinity Grand Marketing LLC (Although the information may be similar to what is typically provided on an IRS W-9 Form, an IRS W-9 Form may not be submitted in lieu of this Trinity Grand Marketing LLC Substitute W-9 Form).In order to comply, we ask that you provide the following information:
1.Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2. Business name/disregarded entity name, if different from above
3. Check appropriate box for federal tax classification; check only one of the following seven boxes:
If limited liability company is selected, Enter the tax classification (C=C corporation, S=S corporation, P=partnership)
Note. Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.
4. Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any)
Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.)
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.
Social security number
Employer identification number
Part II Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
3. I am a US citizen or other US person. Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For Mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN.
COVID 19 WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
In consideration for receiving permission to commence services on behalf of Trinity Grand Marketing, LLC (hereinafter the “Activity or Activities”), I, on behalf of myself and any minor child/children for whom I have the capacity to contract, hereby acknowledge and agree to the following:
IN SIGNING THIS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read the foregoing Wavier of Liability and Hold Harmless Agreement, understand it and sign it voluntarily as my own free act and deed; no oral representations, statements, or inducements, apart from the foregoing written agreement, have been made; I am at least eighteen (18) years of age and fully competent; and I execute this Agreement for full, adequate and complete consideration fully intending to be bound by same.
Agree & Sign
I agree that I have read and understand, the entirety of this document including the following sections and accept its terms and conditions. I Agree
INDEPENDENT CONTRACTOR AGREEMENT
COMPANY., POLICY PROHIBITING SEXUAL HARASSMENT
Substitute for Form W-9 Request for Taxpayer Identification Number
COVID 19 RELEASE OF LIABILITY WAIVER
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Document Name: Test Today USA LLC NC Independent Contractor Agreement
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