Fillable University Of Florida - Vendor Tax Information Form

Will you be reimbursed for any expenses that you incur while performing the proposed work/service?

Yes (Please

describe)

___________________________________________________________________________________________________________

10. What is the total expected compensation for the work/services performed? Actual ________________ Projected ________________

11. How will costs be billed and paid (invoice based on actuals, per task completion, hourly rate, etc.) and at what payment frequency?

___________________________________________________________________________________________________________

Part 4

– Certification:

Under penalties of perjury, I certify that:

1. The taxpayer identification number provided on this form is correct (or I am waiting for a TIN 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 failure to report all interest or dividends, or (c) the IRS has

notified me that I am no longer subject to backup withholding.

3. I am a U.S. Person (including a U.S. resident alien).

As a vendor performing service for the University of Florida, I understand that I am not covered under the State of Florida Worker's Compensation

Law (F.S. 440) and it is my responsibility to obtain personal liability insurance. I am also aware that all taxes attributable to any service that I

render to the University of Florida are my responsibility.

____________________________________________________________

__________________

_______________

Signature of U.S. Person (Payee)

Phone

Date

ANY TAXES, INTEREST OR PENALTIES ASSESSED AGAINST THE UNIVERSITY OF FLORIDA BY THE IRS DUE TO MISCLASSIFICATION

OF AN INDIVIDUAL AS AN INDEPENDENT CONTRACTOR WILL BE PAID BY THE DEPARTMENT AUTHORIZING THE CONTRACTUAL

RELATIONSHIP.

_________________________________________________________________________________________________________________

Univ. of FL Department

_______________________________________________

_________________________________________

_____________

Univ. of FL Dean, Director, Chairperson Name or Designee

Signature

Date

Once completed, please return to the UF department you are currently working with. The department will be responsible for obtaining the

appropriate signature of their department chair, dean, or director and submitting the form to Vendor Maintenance at:

Mail: Vendor Maintenance

PO Box 115350

Gainesville, FL, 32611-5350

Fax: 352-392-0081 eMail:

addvendor@ufl.edu

FA-UDS-VTIF

4/2016

University Of Florida - Vendor Tax Information Form - 2016 Page 2