Consultant Fee Agreement Sample (Page 2 of 3) in pdf

SAMPLE CONSULTANT AGREEMENT

AMENDMENTS

This Agreement may be amended from time to time by written Amendments

approved by both parties.

STATUS OF PARTIES

Contractor is working as an independent contractor. UMMC is not responsible for

payment of employment taxes, benefits or insurance. The independent contractor is

responsible for income and employment taxes related to the fees paid under this

agreement. UMMC complies with Internal Revenue Service regulations on 1099 tax

reporting for payments made to independent contractors.

Each party to this contract is responsible for its own acts or actions and for the actions

of its employees or agents. As UMMC is a state supported educational entity, any

liability claims will be handled under the Mississippi Tort Claims Act, M.C.A. 11-46-

1 et seq., subject to the Act’s limitations.

CONFIDENTIALITY

The parties agree that any information given by UMMC to the Contractor, or that the

Contractor comes in contact with, during the performance of this contract shall

remain confidential.

COMPLIANCE

As part of UMMC’s overall Compliance Program, contractor shall establish

procedures and insure adherence for its employees to all appropriate state and federal

statues including but not limited to, the Start I, 42 USC §411 and Stark II, 42 USC

§1395, bans on self referrals, the False Claims Act, 31 USC §3729, anti-kickback

statutes, 42 USC §415, HIPAA, the Medicare carrier manual, Medicare and Medicaid

statutes and regulations and the Balanced Budget Act. Any acts pursuant to this

agreement shall be done in compliance with the applicable rules and regulations of

The Joint Commission and any third party payer.

Vendor/contractor certifies that it has not been disqualified in any manner from any

federally funded program and is not debarred or limited in any manner from the

participation in the matters upon which this agreement is based. Vendor/contractor

further affirms that it is in compliance with the Mississippi Employment Protection

Act [MEPA] and will indemnify and hold harmless UMMC for any action arising

from the violation or failure to comply with employment verification procedures as

required but the state of Mississippi or Federal laws and regulations in regard to the

same.

Contractor also agrees that he will comply with the requirements stated in the above

reference contract.

Consultant Fee Agreement Sample Page 2