UNIVERSITY OF CINCINNATI

 LIMITED SERVICES ENGAGEMENT FORM

 

 

of

 

Name

 

Street Address

 

having

City / State / Zip Code

 

social security number

 

hereby agrees to perform

limited services for the University of Cincinnati on

 

 

Date(s)

 

described as follows:

 

 

_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

In consideration of the performance of the above, the University of Cincinnati will compensate me in the amount of $____________________

I hereby certify that, in performing these services, I am at all times an independent contractor and not an employee of the University of Cincinnati.

 

 

 

 

Independent Contractor Signature

 

Date

  Instructions:  To pay the independent contractor, attach this form to the Request for Payment, Form A-114.  Refer to the Fiscal Operating Policies and Procedures Manual, Section 6.1-21, for the appropriate use of the Limited Services Engagement Form.