Laserfiche WebLink
<br /> <br /> (Retirement Form Approved by City Attorney’s Office June 15, 2014) <br /> <br />STATE RETIREMENT SYSTEMS FORM <br />ATTACHMENT TO PROFESSIONAL SERVICES AGREEMENT <br />ALL ARTISTS MUST COMPLETE AND SIGN THIS FORM <br /> <br /> <br />1. Does Artist have twenty-five (25) or more employees? Yes No <br />IF YES: SKIP QUESTION 2, SKIP QUESTION 3, AND SIGN BELOW. <br />IF NO: ANSWER QUESTIONS 2 AND 3. <br /> <br />2. If a Artist employee will perform Work under this Professional Services Agreement, did that <br />employee retire under the Public Employers’ Retirement System (PERS), School Employees’ <br />Retirement System (SERS), Teachers’ Retirement System (TRS), or Law Enforcement Officers and <br />Fire Fighters plan (LEOFF)? Yes No <br /> <br />3. Answer the appropriate question below for Artist’s business organization: <br /> <br />Sole Proprietor. Did Artist retire under the Public Employers’ Retirement System (PERS), School <br />Employees’ Retirement System (SERS), Teachers’ Retirement System (TRS), Law Enforcement <br />Officers and Fire Fighters plan (LEOFF)? Yes No <br /> <br />Partnership. If a partner will perform Work under this Professional Services Agreement, did that <br />partner retire under the Public Employers’ Retirement System (PERS), School Employees’ <br />Retirement System (SERS), Teachers’ Retirement System (TRS) or Law Enforcement Officers and <br />Fire Fighters plan (LEOFF)? Yes No <br /> <br />Limited Liability Company. If a member will perform Work under this Professional Services <br />Agreement, did that member retire under the Public Employers’ Retirement System (PERS), School <br />Employees’ Retirement System (SERS), Teachers’ Retirement System (TRS) or Law Enforcement <br />Officers and Fire Fighters plan (LEOFF)? Yes No <br /> <br />Corporation. If a shareholder will perform Work under this Professional Services Agreement, did <br />that shareholder retire under the Public Employers’ Retirement System (PERS), School Employees’ <br />Retirement System (SERS), Teachers’ Retirement System (TRS), or Law Enforcement Officers and <br />Fire Fighters plan (LEOFF)? Yes No <br /> <br />IF THERE IS A “YES” ANSWER TO ANY PART OF QUESTIONS 2 OR 3, AN <br />ADDITIONAL QUESTIONNAIRE (AVAILABLE FROM HR OR LEGAL) MUST BE <br />FILLED OUT AND SUBMITTED WITH THE CONTRACT. <br /> <br />Artist Name:_________________________________ <br /> <br /> <br />Signature: ____________________ Printed Name: _____________ Title: ______________ <br /> <br />