CSM REIMBURSEMENT PROCEDURES “Employees responsible for spending or approving ex- penditure of NDSU funds or incurring any reimbursable expenses must comply with all applicable laws and poli- cies and use good judgment on behalf of NDSU to ensure that good value is received for every expenditure. NDSU funds and all other assets are for NDSU purposes only and not for personal use or benefit.” NDSU Policy 151 In This Guide: Travel Reimbursements Non-Travel Reimbursements Receipts Guest Speakers Feeling overwhelmed by the documentation needed for reimbursements? CSM Reimbursements There have recently been a lot of changes to the reimbursement process, not only due to the reorganization of the CSM Business Center, but also because NDSU is getting a bit stricter on its reim- bursement procedures. More documentation is needed, more justi- fication, etc. I understand that this has created quite a bit of confusion...how things were done in the past by the individual departments, as op- posed to how things are done now with the combined CSM Busi- ness Center. This guide has been put together to help alleviate some of the con- fusion, and hopefully answer questions as to why things are now done in a certain way. The main areas this guide will cover are: Travel reimbursements. Non-travel reimbursements (i.e., meals). Receipts—what we are looking for. Guest speakers—what forms you need . February 2018 1
Transcript
CSM REIMBURSEMENT PROCEDURES
“Employees responsible for
spending or approving ex-
penditure of NDSU funds or
incurring any reimbursable
expenses must comply with
all applicable laws and poli-
cies and use good judgment
on behalf of NDSU to ensure
that good value is received
for every expenditure. NDSU
funds and all other assets
are for NDSU purposes only
and not for personal use or
benefit.”
NDSU Policy 151
In This Guide:
Travel
Reimbursements
Non-Travel
Reimbursements
Receipts
Guest Speakers
Feeling overwhelmed by the documentation needed for reimbursements?
CSM Reimbursements There have recently been a lot of changes to the reimbursement
process, not only due to the reorganization of the CSM Business
Center, but also because NDSU is getting a bit stricter on its reim-
bursement procedures. More documentation is needed, more justi-
fication, etc.
I understand that this has created quite a bit of confusion...how
things were done in the past by the individual departments, as op-
posed to how things are done now with the combined CSM Busi-
ness Center.
This guide has been put together to help alleviate some of the con-
fusion, and hopefully answer questions as to why things are now
done in a certain way.
The main areas this guide will cover are:
Travel reimbursements.
Non-travel reimbursements (i.e., meals).
Receipts—what we are looking for.
Guest speakers—what forms you need .
February 2018
1
For travel reimbursements, you will need the following forms:
Travel Authorization—Out-of-State (approved)
CSM Travel Expense Reimbursement Request
Receipts
For non-travel reimbursements, you will need the following forms:
CSM Request for Employee/Student Reimbursement Non-
Travel Expense Form
Banquet and meeting Documentation
Receipts
For guest/colloquium speakers, you will need the following forms:
Contracted Services Agreement—Speaker
W-9 if they will be paid travel expenses and/or speaker fees/
honorariums; for guest speakers who are foreign nationals, use
form W-8BEN.
Receipts
For all undergraduate and graduate student travel:
Payment for Student Travel Accounting related questions? Please call (701) 231-7432
Financial Aid related questions? Please call (701) 231-8427 Student Name: Student ID#:
The following is to be used to guide students, faculty, PI's and administrative staff on the proper procedures for processing student travel in order to maintain compliance with IRS and federal financial aid regulations.
The Higher Education Act of 2008 (the first HEA became law in 1965) defines other financial assistance as any other assistance known to the school. If the assistance was a result of enrollment, but not a result of employment, the school must treat it as a financial aid resource. Assistance is distinguished from reimbursement for expenses. Reimbursement for expenses can only occur if there was a business related reason for the student to have incurred the expense. Non-business related payment would be considered assistance and must be reported to Financial Aid and Scholarships.
The primary factor in defining whether travel is business-related or a scholarship is determining the primary beneficiary. Student travel is considered NDSU business related travel if the University is the primary beneficiary and the travel is incurred for University business.
I certify that, to the best of my knowledge, all information provided on this form is complete and accurate.
Name of individual complete form (printed) Phone Number
Signature (Faculty, Principal Investigator, Administrator) Date
ACCT-PayStudentTravel- REV 05/2017 (10ACFY) Page 1 of 1
If any of the below items apply, the travel may be deemed NDSU business-related. Please complete an Accounts Payable Voucher, along with this completed form and route to the NDSU Accounting Office (signature(s) below are required).
To request payment through Accounts Payable, please check all that apply: The primary purpose of the travel directly supports the faculty/PI's project or research program.
Research results will be used by NDSU.
Presenting at a conference on behalf of NDSU. Please attach a copy of the conference program.
The student is officially representing NDSU. Further explanation is required:
If none of the above items apply to the student's travel, it is deemed to be necessary to the student's program of study and should be processed as a scholarship. Please complete the bottom section of this form and submit this form to Michelle Marks in Financial Aid and Scholarship or via e-mail at [email protected].
To request payment through an existing scholarship, complete the following information:
Department Name: Department #:
Scholarship Name:
Amount to be Awarded: Semester to be dispersed to student:
If this will be paid through a new scholarship, please complete the New Scholarship Request Form.
Non-Travel Reimbursements The main non-travel reimbursement you will deal with are reim-
bursements for meals with guest and colloquium speakers.
One form you will have to fill out is the Banquet & Meeting Docu-
mentation Form. On this form, you will have to list the name of
each guest attending that meal.
There is a per person allowance limit to reimbursed meals that is actually printed on the banquet form to remind you how much is allowable:
Breakfast is $12.75 per person. Lunch is $19.13 per person. Dinner is $31.88 per person.
Remember: these amounts include taxes and gratuity.
The form will figure the average cost of the meal for you—just put the total amount of the meal requested, enter the number of indi-viduals, and the average cost of meal is automatically filled in.
The individual who is paying for the meal and requesting reim-bursement should print and sign their name at the bottom of the form.
Other non-travel reimbursements, such as lab, equipment or office supplies should not be put on your personal credit card for reim-bursement. Such purchases should use the department pcard so that taxes are not charged on the items. As the university gets stricter on the use of personal credit cards for official purposes (other than meals), it is easier to just avoid this practice.
For reimbursement purposes, you will need to provide 2 receipts:
Itemized receipt.
Receipt showing method of payment.
(Samples of these two types of receipts are shown on the next page.)
Don’t forget...just like the travel reimbursement request, there is a non-travel reimbursement request.
This will provide who is to be reimbursed, what the event was for, and funding information.
If you get a receipt that shows both the itemized list of the purchase, plus the method of payment, then
you will only need that one receipt.
The itemized receipt is to ensure that no unallowable purchases are made, i.e., with a restaurant receipt,
there is no alcohol being reimbursed.
If you have alcohol with a meal and want to be reimbursed, make sure it is on a separate receipt, and it
can be paid through Development Foundation funds.
The receipt showing method of payment shows that the items were paid, if there was a gratuity added,
who paid, and how (cash or credit card).
When adding a gratuity to the restaurant meal, please note that it cannot be more
than 20% of the total meal. If you tip over 20%, you will not be reimbursed for any
amount over the allowable 20% maximum gratuity.
Requiring these receipts helps avoid fraud within the university system.
10
11
02/01/18 16:44 0622 08172 007 2458
HARK E 9600116�2 Cl UU CRKS F E 900088474 NAANDIPPERSF E 980086474 HAANDIPPERSF E 102193 36CT COOKIEF E 608620 VE6 TRAY F E 72553 RED GRAPES FE 406950 RR� HUHHUS F
747420 HH PLATE E 431584 HAVARTI F E 377273 PRESBRIE16.F E 980081189 CHRCTRE SHPF E 749972 STRAUBERRY F E 725545 GREEN BRAPEF
SUBTOTAL
fd8 H 4.68 H 4.68 H 5.98 H 9.98 N 7.98 H 5.88 N
12.94 T7.23 H 6.28 N
11. 98 H5.98 N6.98 N
97.55
TAX 1 7.500 t 0.97 TOTAL 98.52
VISA TENO �
· 52VISA CREDIT **** **** *** I 1 APPROVAL# 810140
- Payment to supplier online in PeopleSoft - attach completed form to invoice and retain in office- Payments to NDSU Dining Services, via electronic billings - attach completed form to NDSU Dining Services invoice and retain in office
• Original itemized receipts must be attached• Alcoholic beverages CAN NOT be included in the reimbursement amount requested.Requestor InformationIndividual/Supplier Name:
Individual/Supplier ID: (optional)
Funding (optional):
Purpose of banquet/meeting:
Requested Amount: Number of Individuals: Average Cost of Meal:
This reimbursement is for: Breakfast Lunch Dinner The current North Dakota GSA rate per day is $51.00. 125% of the current rate is $63.75. GSA rates are updated annually in October. The upper limit of $63.75 is broken down by quarter as follows: breakfast $12.75, lunch $19.13, dinner $31.88. If the average cost per meal as selected above is more than the amount allowed per person, additional written justification is required. Please attach a separate sheet. For further information on this please see NDUS Procedure 806.1 Payment or Reimbursement of Meals.
An approval signature from the Vice President for you division is required for all meals that exceed the reasonable amount limit set by NDUS. For audit purposes, list all individuals and their titles that are attending: (attach an additional sheet if necessary)
1. Name: Title:
2. Name: Title:
3. Name: Title:
4. Name: Title:
5. Name: Title:
6. Name: Title:
7. Name: Title:
8. Name: Title:
9. Name: Title:
10. Name: Title:
I certify that, to the best of my knowledge, all information included on this "Banquet and Meeting Documentation" form is complete and accurate. I understand that I will be subject to disciplinary action in accordance with the NDSU Code of Conduct (Policy 151.1) should the information be false or misleading.
ACCT-BanquetMeetingDoc 1- REV 10/2016 (10ACFY) Page 1 of 1
Signature of individual being reimbursed or authorized signature for supplier payment Date
Print name
Additional Signature (if required) Date
Print name
Banquet & Meeting Documentation For meals AFTER October 1, 2015
Questions about this form? Please call 701-231-7432
13
Why Do I Need a Contracted Speaker Agreement?
It clarifies what is ex-
pected from both parties
in that it specifies what
services the guest speak-
er will provide.
It specifies the date(s)
and time(s) the speaker is
to provide his/her ser-
vices.
It specifies what the re-
sponsibilities to the
speaker that NDSU has.
For instance, is there go-
ing to be an honorarium
paid, or is the university
just picking up travel ex-
penses?
Finally, and most im-
portantly, it clarifies the
relationship between the
speaker and the universi-
ty.
The speaker is an
independent contrac-
tor and is not an em-
ployee of NDSU.
The speaker is not
subject to the super-
vision and control of
NDSU.
Each of the parties
are solely and entirely
responsible for its
own acts and/or the
acts of its employees
or agents.
No benefits provided
by NDSU to its em-
ployees will be pro-
vided to the speaker.
Guest Speakers For any guest or colloquium speaker com-ing from outside the area, you should have a Contracted Services Agreement—Speaker. This is a simple, one page form that should be filled out and signed prior to the speaker arriving.
In most instances, travel expenses are paid for the speaker by the department and this should be stipulated in the compensa-tion section so that there is no ambiguity as to what the university is providing for the guest speaker.
Once the form is filled in, then the speaker needs to sign it, the de-partment chair should sign it, and final approval is sent to Stacey Winter in Purchasing (the form can be forwarded to the Account Tech and he/she can acquire the signature from Purchasing). Once Purchasing signs/approves the form, it will be kept with the other forms where the department is paying for any expenses for the speaker.
Honorariums/Speaker Fees:
Some departments pay their speakers an honorarium or speaker fee, and if so, this should be stipulated in the compensation section of the contract. If there is no honorarium/speaker fee paid, nor any travel reimbursements, there is no need for a W-9 to be completed by the speaker.
If the guest speaker is going to be paid an honorarium (or speaker fee when paid by grant funding), then an additional W-9 form must be filled out and signed by the guest speaker. This is because the honorarium/speaker fee is considered income, and the W-9 is an IRS form.
Foreign Guest Speakers
The agreement you’d use for foreign guest speakers would be the Contracted Services Agreement—Non-Resident Alien. This form is similar to the simpler speaker agreement shown earlier, but the up-side is that this form also gives you a list of the documents that are required to go with this form (if the speaker is being paid).
Payments to the individual get a little tricky when the speaker is a foreign national, as they don ’t have a social security number. In that case, they would need to complete the W-8BEN (Certificate of Foreign Status of Beneficial Owner for United States Tax Withhold-ing and Reporting—Individuals). For identification purposes, it’s a good idea to get a copy of their passport in lieu of other identifica-tion. If there is no honorarium or speaker fee, or travel reimburse-ments being paid to the individual, then the W-8BEN is not re-quired.
Normally, the Contracted Services Agreement-Speaker will only be used for out-of-state guest speakers.
Make sure the guest speaker indicates their citizenship or NDSU employee status here.
This Agreement is entered into between North Dakota State University - NDSU DEPARTMENT hereinafter referred to as "NDSU" and JOHN SMITH hereinafter referred to as "Contractor". Name and Address of Contractor:
Name: JOHN SMITH
Address: 123 OAK AVENUE, PINE BLUFF, MT 00000 Street Address City State Zip
Phone #:123-456-7890
Is Contractor a current NDSU Employee? Yes No If yes, all NDSU employees must be paid through the HR/Payroll System. Please see Relationship of the Parties section below. (Contracted Services Agreements cannot be used for employees.)
Is Contractor a past NDSU Employee? Yes No If yes, list last date of employment: Services: The services the Contractor agrees to provide are: COLLOQUIUM FOR "NAME" DEPARTMENT TITLE: "NAME OF TITLE OF GUEST SPEAKER'S TALK"
Time: The Contractor shall perform the services to the satisfaction of NDSU at the following date(s) and time(s): FEB 25, 2018, 3:30 PM
Compensation: NDSU agrees to pay the Contractor as follows: TRAVEL EXPENSES (AIRFARE, HOTEL) HONORARIUM: $300.00
If there is an honorarium, or speaker fee paid, you will also need a W-9 (for U.S. citizens, or a W-8BEN (for foreign nationals) for IRS purposes.
Relationship of the Parties: It is mutually agreed the Contractor is an independent contractor and not an employee of NDSU for purposes of this agreement. It is understood that the Contractor is not subject to the supervision and control of NDSU. No agency, employment or partnership is created by this Agreement. Each of the parties will be solely and entirely responsible for its own acts and/or the acts of its employees or agents. No benefits provided by NDSU to its employees, including unemployment and workers' compensation insurance, will be provided to the Contractor or his/her/its employees. Disclosure: “NDSU has an obligation to make information available to the campus on where to get information about Registered Sex Offenders who are working on NDSU property. You are obligated to inform NDSU Campus Police, in advance of any of your employees being on NDSU property, of any such employee who is a Registered Sex Offender. This obligation includes property owned or controlled by NDSU that is at locations other than the main campus (for example, the Equine Center, Downtown Campus, Research Extension Centers, etc.).” Non-discrimination: The Contractor agrees that no part of this Agreement shall be performed in a manner which illegally discriminates against any person on the basis of age, color, physical or mental disability, pregnancy, gender expression/identity, genetic information, marital status, national origin, public assistance status, race, religion, sex, sexual orientation, or status as a U.S. Veteran.
Certification: Acceptance of this contract constitutes certification that the Recipient is not proposed for disbarment, declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency.
Contractor Signature Date JOHN SMITH Print Contractor Name
Are you a U.S. citizen, U.S. national, or a permanent resident of the United States?
Yes No Are you a current or past NDSU Employee? Yes No
If yes, please see Relationship of the Parties section above.
Dept Authorized SignatureDEPARTMENT CHAIR The department chair, or other authorized person
should sign. Print Dept Authorized Name
NDSU Director of Purchasing Signature Date
STACEY WINTER Print Director of Purchasing Name
PUR-SpeakerAgreement - Rev 10/2016 Page 1 of 1
Contracted Services Agreement - Speaker
Questions about this form? Please call (701) 231-8954.
This is to ensure there is no question as to what expenses NDSU is providing to the guest speaker.
Please print this form.
Route this form to: Purchasing 17 Old Main Phone: (701) 231-8954 Fax: (701) 231-7050
15
This Agreement is entered into between North Dakota State University - hereinafter referred to as "NDSU" and hereinafter referred to as "Contractor". Name and Address of Contractor:
Name:
Address: Street Address City State Zip
Phone #:
Is Contractor a current NDSU Employee? Yes No If yes, all NDSU employees must be paid through the HR/Payroll System. Please see Relationship of the Parties section below. (Contracted Services Agreements cannot be used for employees.)
Is Contractor a past NDSU Employee? Yes No If yes, list last date of employment: Services: The services the Contractor agrees to provide are:
Time: The Contractor shall perform the services to the satisfaction of NDSU at the following date(s) and time(s):
Compensation: NDSU agrees to pay the Contractor as follows:
Relationship of the Parties: It is mutually agreed the Contractor is an independent contractor and not an employee of NDSU for purposes of this agreement. It is understood that the Contractor is not subject to the supervision and control of NDSU. No agency, employment or partnership is created by this Agreement. Each of the parties will be solely and entirely responsible for its own acts and/or the acts of its employees or agents. No benefits provided by NDSU to its employees, including unemployment and workers' compensation insurance, will be provided to the Contractor or his/her/its employees. Disclosure: “NDSU has an obligation to make information available to the campus on where to get information about Registered Sex Offenders who are working on NDSU property. You are obligated to inform NDSU Campus Police, in advance of any of your employees being on NDSU property, of any such employee who is a Registered Sex Offender. This obligation includes property owned or controlled by NDSU that is at locations other than the main campus (for example, the Equine Center, Downtown Campus, Research Extension Centers, etc.).” Non-discrimination: The Contractor agrees that no part of this Agreement shall be performed in a manner which illegally discriminates against any person on the basis of age, color, physical or mental disability, pregnancy, gender expression/identity, genetic information, marital status, national origin, public assistance status, race, religion, sex, sexual orientation, or status as a U.S. Veteran.
Certification: Acceptance of this contract constitutes certification that the Recipient is not proposed for disbarment, declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency.
Contractor Signature Date
Print Contractor Name Are you a U.S. citizen, U.S. national, or a permanent resident of the United States? Yes No Are you a current or past NDSU Employee? Yes No
If yes, please see Relationship of the Parties section above.
Dept Authorized Signature Date
Print Dept Authorized Name
NDSU Director of Purchasing Signature Date
Print Director of Purchasing Name
PUR-SpeakerAgreement - Rev 10/2016 Page 1 of 1
Contracted Services Agreement - Speaker
Questions about this form? Please call (701) 231-8954.
Please print this form.
Route this form to: Purchasing 17 Old Main Phone: (701) 231-8954 Fax: (701) 231-7050
16
Employer identification number
–
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 instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
Social security number
– –
TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.
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); and2. 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 amno longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.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. See the instructions for Part II, later.
General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.
Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid)
• Form 1099-DIV (dividends, including those from stocks or mutualfunds)• Form 1099-MISC (various types of income, prizes, awards, or grossproceeds)• Form 1099-B (stock or mutual fund sales and certain othertransactions by brokers)• Form 1099-S (proceeds from real estate transactions)• Form 1099-K (merchant card and third party network transactions)• Form 1098 (home mortgage interest), 1098-E (student loan interest),1098-T (tuition)• Form 1099-C (canceled debt)• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a residentalien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later.
Cat. No. 10231X Form W-9 (Rev. 11-2017)
Sign Here
Signature of U.S. person ▶ Date ▶
Prin
t or t
ype.
Se
e Sp
ecifi
c In
stru
ctio
ns o
n pa
ge 3
. Form W-9(Rev. November 2017) Department of the Treasury Internal Revenue Service
Request for Taxpayer Identification Number and Certification
▶ Go to www.irs.gov/FormW9 for instructions and the latest information.
Give Form to the requester. Do not send to the IRS.
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 of the person whose name is entered on line 1. Check only one of the following seven boxes.
Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate single-member LLC
Limited liability company. 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.
Other (see instructions) ▶
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.)
5 Address (number, street, and apt. or suite no.) See instructions. Requester’s name and address (optional)
PUR-ContractorAgreement-NRAlien.pdf - Rev 10/2016 Page 1 of 3
Documents/Forms required for payment of services within the United States: •Copy of I-94 Card 'Arrival and Departure Record'•Copy of Passport•Copy of Visa•Foreign National Information Form
Additional form required for payment of services regardless of where services are performed: •W-8BEN
I hereby certify to the following facts:
The activities will last no longer than nine (9) days at this institution.
The services are being conducted for the benefit of the institution; and
I have not accepted honoraria (and incidental expenses in the case of a B-2 visitor) from more than 5 institutions or organization in the previous six (6) months.
This Agreement is entered into between North Dakota State University - Department Name
hereinafter referred to as "NDSU" and Contractor's Name hereinafter referred to as "Contractor".
Name and Address of North Dakota State University Contact Person: Department Name:
Contact Name: Phone Number:
Name and Address of Non-Resident Alien: Individual's Name:
Address:
Country: (do not abbreviate)
Phone Number:
Is Contractor a current NDSU Employee? Yes No If yes, all NDSU employees must be paid through the HR/Payroll System. Please see Relationship of the Parties section below. (Contracted Services Agreements cannot be used for employees.)
Is Contractor a past NDSU Employee? Yes No If yes, list last date of employment:
Services: The services the Contractor agrees to provide are: Describe services --
Is this service being performed within the United States? Yes No
Effective Date and Duration: This contract shall be for the period of Start Date through End Date with an option to be extended for an additional # or N/Amonths for a maximum of up to # or N/Ayears if mutually agreed upon by both parties as set forth in a written amendment to this contract.
18
PUR-ContractorAgreement-NRAlien.pdf - Rev 10/2016 Page 2 of 3
Contracted Services Agreement North Dakota State University
Compensation: NDSU agrees to pay the Contractor as follows:
Amount and date payment to be tendered --
Foreign persons are subject to U.S. tax at a 30% rate on income they receive from U.S. sources for services performed in the U.S.. This tax is imposed on the gross amount paid and is generally collected by withholding under IRS section 1441 or 1442 on that amount. It is the University's responsibility to withhold tax. In some cases a reduced rate or exemption from withholding due to a tax treaty, may be allowed for individuals only.
Relationship of the Parties: It is mutually agreed the Contractor is an independent contractor and not an employee of NDSU for purposes of this agreement. It is understood that the Contractor is not subject to the supervision and control of NDSU. No agency, employment or partnership is created by this Agreement. Each of the parties will be solely and entirely responsible for its own acts and/or the acts of its employees or agents. No benefits provided by NDSU to its employees, including unemployment and workers' compensation insurance, will be provided to the Contractor or his/her/its employees.
Disclosure: “NDSU has an obligation to make information available to the campus on where to get information about Registered Sex Offenders who are working on NDSU property. You are obligated to inform NDSU Campus Police, in advance of any of your employees being on NDSU property, of any such employee who is a Registered Sex Offender. This obligation includes property owned or controlled by NDSU that is at locations other than the main campus (for example, the Equine Center, Downtown Campus, Research Extension Centers, etc.).” Materials: No products or building materials used as a temporary or permanent element in the construction of a building will be allowed which have any form of asbestos containing material. Contractors shall be responsible to monitor shop drawings and product literature to verify the make-up of materials to be used in the building, and to remind material suppliers that their products must not contain asbestos. Contractors shall notify the NDSU Project Manager and the Project Architect/Engineer (if applicable) immediately of any materials which are suspected of containing asbestos, and shall not disturb or attempt to abate any asbestos containing materials.
Access to Records: The Contractor shall adequately account for and maintain reasonable records for his performance under this Agreement and allow access to these records by NDSU, the ND State Auditor or their agents as may be necessary for audit purposes and in determining compliance with the terms of this Agreement.
The Contractor shall submit a record of expenditures incurred for the performance and completion of this agreement. NDSU may verify all expenditure receipts and disperse funds in an amount equal to the approved expenditures.
The Contractor must retain all records pertaining to this Agreement for a period of three years from the completion date of this Agreement. If any litigation, claim or audit is started before the expiration of the three-year period, the records must be retained until the litigation, claim or audit findings have been resolved.
Indemnification: The Contractor agrees to indemnify, save and hold harmless the State of North Dakota, its agencies, officers and employees (State) from any and all claims of any nature, including costs, expenses and attorney fees which may in any manner arise out of or the result from any acts or omissions in performing work or activities under the Agreement, except for claims arising out of the State's own acts.
Insurance: The Contractor shall secure and keep in force during the term of this Agreement from insurance companies authorized to do business in the North Dakota:
1) commercial general liability; 2) automobile liability 3) workers compensation insurance (if required by law), all covering the Contractor for any and allclaims of any nature including all costs, expenses, and attorneys' fees that may in any way arise out of or the result of this agreement.
The Contractor shall furnish the NDSU contact person with a certificate of insurance as evidence that these policies are in effect. The minimum limits of liability are:
Commercial general liability & Automobile liability - $250,000 per person and $1,000,000 per occurrence. Workers Compensation - statutory limits.
These policies may not be canceled or modified without thirty- (30) day's prior written notice to NDSU.
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Contracted Services Agreement North Dakota State University Non-discrimination: The Contractor agrees that no part of this Agreement shall be performed in a manner which illegally discriminates against any person on the basis of age, color, physical or mental disability, pregnancy, gender expression/identity, genetic information, marital status, national origin, public assistance status, race, religion, sex, sexual orientation, or status as a U.S. Veteran.
Certification: Acceptance of this contract constitutes certification that the Recipient is not proposed for disbarment, declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency.
Modification: This Agreement contains the entire agreement between the parties, and no statements, promises or inducements made by either party, or agents or either party, that are not contained in this agreement are valid or binding. This Agreement may not be enlarged, modified, or altered except by written amendment by the parties. Termination: This Agreement may be terminated at any time upon the written mutual consent of the parties. Either party may terminate or suspend performance of this Agreement for failure of the other party to perform any of the services, duties or conditions contained in this Agreement after giving the other party written notice of the stated failure. The written notice must demand performance of the stated failure within a specified period of time of not less than 30 days. If the demanded performance is not completed within the specified period, the termination is effective at the end of the specified period. NDSU may also terminate this Agreement if at the end of a State biennial period, the North Dakota State Legislature has not appropriated sufficient funds in the next biennium for the payment(s).
The above remedies are in addition to any other remedies provided by law or the terms of the agreement.
Severability: If one part of this agreement is held to be illegal, void or in conflict with any North Dakota law, the validity of the remainder of this agreement remains operative and binding.
Assignment, Transfer and Subcontracting: There will be no assignment or transfer of this Agreement, or of any interest in this Agreement, unless both parties agree in writing. No services required under this Agreement may be performed under subcontract unless both parties agree in writing.
Notice: All notices relating to this Agreement will be in writing and given to the contact person at the address provided for in the Agreement.
Venue: This Agreement will be controlled and interpreted according to the laws of the State of North Dakota. Venue for any actions arising from this Agreement shall be in Cass County, State of North Dakota.
Parking Regulations: Vendors, Contractors and Service Providers: Vendors, contractors, consultants, and service providers may be eligible to purchase an annual vendor permit for the academic school year by submitting an application to NDSU Parking and Transportation Services. Annual vendor permits are not allowed in: no parking zones, fire lanes, sidewalks, state fleet lot, and reserved spaces. Vendors who perform services to University buildings and property, in easily recognizable service vehicles painted with a "branded/logo signature" or an appropriately sized magnetic or attached sign, are allowed to park in a reasonable manner on campus. Contractors working on designated projects may be assigned to a specific lot or area. For more information: http://www.ndsu.edu/parking/parkingregulations/
Execution:
Contractor Signature Date
Print Contractor Name
Are you a U.S. citizen, U.S. national, or a permanent resident of the United States? Yes No
Are you a current or past NDSU Employee? Yes No If yes, please see Relationship of the Parties section above.
Copy of the certificate of insurance has been/is being provided to contact person at NDSU? See Insurance section above. Yes No
Dept Authorized Signature Date
Print Dept Authorized Signature Name
NDSU Director of Purchasing Signature Date
Print Director of Purchasing Name
Please print this form.
Route this form to: Purchasing 17 Old Main Phone: (701) 231-8954 Fax: (701) 231-7050
Department of the Treasury Internal Revenue Service
Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding and Reporting (Individuals)
▶ For use by individuals. Entities must use Form W-8BEN-E.▶ Go to www.irs.gov/FormW8BEN for instructions and the latest information.
▶ Give this form to the withholding agent or payer. Do not send to the IRS.
OMB No. 1545-1621
Do NOT use this form if: Instead, use Form: • You are NOT an individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8BEN-E
• You are a U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . . . W-9
• You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S.(other than personal services) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI
• You are a beneficial owner who is receiving compensation for personal services performed in the United States . . . . . . . 8233 or W-4
• You are a person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY Note: If you are resident in a FATCA partner jurisdiction (i.e., a Model 1 IGA jurisdiction with reciprocity), certain tax account information may be provided to your jurisdiction of residence.
Part I Identification of Beneficial Owner (see instructions)
3 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
4 Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate. Country
5 U.S. taxpayer identification number (SSN or ITIN), if required (see instructions) 6 Foreign tax identifying number (see instructions)
7 Reference number(s) (see instructions) 8 Date of birth (MM-DD-YYYY) (see instructions)
Part II Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions) 9 I certify that the beneficial owner is a resident of within the meaning of the income tax
treaty between the United States and that country. 10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article and paragraph
of the treaty identified on line 9 above to claim a % rate of withholding on (specify type of income): .
Explain the additional conditions in the Article and paragraph the beneficial owner meets to be eligible for the rate of withholding:
Part III Certification Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under penalties of perjury that:
• I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or am using this form to document myself for chapter 4 purposes,
• The person named on line 1 of this form is not a U.S. person,
• The income to which this form relates is: (a) not effectively connected with the conduct of a trade or business in the United States,
(b) effectively connected but is not subject to tax under an applicable income tax treaty, or
(c) the partner’s share of a partnership's effectively connected income,
• The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty betweenthe United States and that country, and
• For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner orany withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 daysif any certification made on this form becomes incorrect.
Sign Here Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY)
Print name of signer Capacity in which acting (if form is not signed by beneficial owner)
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 25047Z Form W-8BEN (Rev. 7-2017)
1 Name of individual who is the beneficial owner 2 Country of citizenship
City or town, state or province. Include postal code where appropriate. Country
