212 screenforc19 ICA
Applicant Complete the Following
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Social Security Number
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The Following states require sex and race to obtain information: AL, AR, FL, GA, IA, IN, OR, TX, WI.
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Independent Contractor Agreement
Business Name DBA:
This is an Independent Contractor Agreement (“Agreement”) between “212 Solutions LLC”, (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.
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.
COMPENSATION ADDENDUM-----COVID 19 RT-qPCR Testing
Independent Business Organization (IBO)----National Consultant-----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 HIPAA, Insurance Card, and Lab training course)
“IBO” means the Independent Business Organization assigned by Master Agent, including its respective contractors, employees, managers, officers, owners, directors, partners, subsidiaries and affiliates. “Affiliate” shall be defined as any corporation, firm, partnership, or other entity that directly or indirectly controls, is controlled by, or is under common control with IBO.
IBO WEEKLY PLAN: Contractor 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 Collection Officer (CO), Regional Director (RD), or National Consultant (NC). FAILING TO NOT HONOR YOUR SELECTED SCHEDULE MAY LEAD TO IBO'S DISCONTINUATION OF SERVICES.
Service Fee (SF): Encompasses all parties’ roles in the process. Equates to any lawful act done under the scope of business defined in this agreement in its 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.
PAY CYCLE BY EXAMPLE: The production week for this contract is defined as Monday through Sunday of each week and the Pay Cycles each cover a two week period.
If the pay cycle begins on Monday 1/4/21 then it ends on Sunday 1/10/21. Company pays a draw percentage of the invoiced production within 17 days of receipt. Please refer to Pay Schedule. The remaining percentage of this invoice, assuming claims have been paid to the Laboratory by Insurance and less any adjustments by the lab, for only reasons / dispositions unpayable final total is paid. At that point the Invoice for this pay cycle is considered paid in full. RECONCILING EVERY MONTH AS CLAIMS ARE PAID TO LABORATORY BY INSURANCE is ongoing and exposure is up to 60 days passed the close of a collection week
SERVICE PRODUCTION: From time to time, Company will assist contractor in providing exclusive site locations as well as informing the local community to increase traffic to those sites. IBO will be handling paying all of its own staff, ongoing training/oversight, inventory management as well as equipment supplies, signage required for each site location shall be entered into the event profile geocoder map on MASTER AGENT'S, homepage.
INVENTORY ISSUED: Inventory will be issued based on IBO’s forecasted weekly projections at the discretion of Company. All inventory must be returned upon termination or end of this campaign for final payments and reserves to be released. There will be no charge for nasal swabs not returned. A Ten percent (10%) loss of all saliva swab test kits issued to IBO will not incur a $10.00 fee per/kit that does not equate to a received valid specimen by the Laboratory. Any saliva test kit over the 10% of the total kits issued to IBO will incur a $10.00 fee<> per kit should those kits be deemed damaged, lost, stolen or simply not returned in a new or used condition.
REPORTING: LABORATORY and MASTER AGENT will provide access to a real time BT Ops Portal results portal for all orders submitted by IBO with break down for your leaders to only see their own teams. Additionally, as claims are paid by insurances billed, LABORATORY and MASTER AGENT will provide a bi-weekly report showing each order, if that order has been billed, and if that order has been paid. All orders that have been paid by insurances to LABORATORY shall be shared with IBO with complete transparency.
FINAL RECONCILE: Within 45-60 days after this Agreement terminates once all Orders / claims generated by IBO have been confirmed or denied payments from insurances will result with a final credit for compensation or debit adjustments to be applied with the remaining difference due to either PARTY as applicable.
Background Check fee: Company will deduct up to $20 from Contractor's invoices for each laboratory applicant submitted for screening, ID code and badge approval with 1 or more order processed in the system. Should Contractor provide reports of screenings from time to time of its active sub-contractors including identity verification and reject all applicants for all criminal crimes of moral turpitude including but not limited to battery, domestic violence, assault, theft, fraud, robbery, drug manufacturing / trafficking, multiple DWI or DUI convictions as well as searches relating to sex offender, terrorist watch National data bases then no fee will apply.
Unaccepted Intakes: Any and all mistakes with patient intakes, that can be avoid by the contractor, (including but not limited to spelling errors, transposing numbers, populating fields with inaccurate information) beyond the initial 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. Ongoing, less than a 5% correction rate is acceptable per IBO per month. Examples below can cause a potential chargeback if previously paid a draw:
Reserves: 5% reserves may be held until the expiration of the campaign for any circumstances that may arise from Contractors activity or lack of action to remedy such instances relating to the above aforementioned or to provide resolution should contractor not pay its sub-contractors on time.
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.
This addendum amendment pertaining to the campaign is in addition to the current Schedule B in the Contractor’s existing executed Independent Contract Agreement on file relating to terms for the Vero campaign.
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 .
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) Alberto Flecha / President, C.E.O. of COMPANY / Call and mail to email@example.com
If the complaint is successfully resolved in an informal manner, to the complainant's satisfaction, Alberto Flecha 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 Alberto Flecha.
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 Alberto Flecha 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:
Alberto Flecha / President, C.E.O. of COMPANY / Call and mail to: firstname.lastname@example.org will be promptly investigated. 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, Alberto Flecha 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,
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.
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.
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 consumers 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 PARTNERS
AUTHORIZATION AGREEMENT FOR DIRECT DEPOSITS (ACH CREDITS)
I (we) hereby authorize 212 Solutions 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.
Substitute for Form W-9 Request for Taxpayer Identification Number
Pursuant to Internal Revenue Service Regulations, you must furnish your Taxpayer Identification Number (TIN) to 212 Solutions 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:
212 Solutions 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 212 Solutions 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 212 Solutions LLC. Substitute W-9 Form).In order to comply, we ask that you provide the following information:
3ab. Other (see instructions)
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.
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:
COVID 19 WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT
In consideration for receiving permission to commence services on behalf of Screenforc19, Inc (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:
Business Associate agrees:
Business Associate agrees:
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.
INDEPENDENT CONTRACTOR AGREEMENT
COMPANY., POLICY PROHIBITING SEXUAL HARASSMENT
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Document Name: 212 screenforc19 ICA
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