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Company, and Contractor, in consideration of mutual covenants and promises, made y eac! to t!e ot!er, a"rees#
$% T!is Independent Contractor A"reement estalis!es t!e lac& of employer'employee relations!ip et(een t!e parties%
)% Company and Contractor estalis!ed t!eir Independent relations!ip on# ******************%
+% Contractor did not complete an application to estalis! t!is relations!ip%
,% Contractor (or&s under its o(n name (!en performin" services for Company%
-% Contractor s!all carry usiness cards and maintain a usiness p!one .ot!er t!an t!e residential p!one numer of t!e
undersi"ned a"ent/% Its "ain or loss is Independent of Company "ain or loss%
0% Contractor !as a si"nificant investment in facilities at its principal place of usiness, (!ic! is separate from t!e
residence of its undersi"ned a"ent%
1% Contractor s!all carry usiness liaility insurance and maintain any necessary usiness occupational licenses for its
usiness% Company s!all not cover Contractor (it! its policies or e liale for in2uries incurred doin" (or&% T!is s!all not ar
ne"li"ence claims due to Company employees or facilities% Contractor s!all !old Company !armless from actions rou"!t y
ot!ers, for ta3es or ot!er(ise, due to its (or&% If t!e Contractor occupation re4uires any form to ma&e t!is A"reement
effective t!en t!e Contractor s!all attac! it%
5% Contractor may do similar (or& for ot!ers any time it (is!es, includin" on t!e same day it does (or& for Company%
Company s!all not !ave a priority on Contractor time and effort% T!e Contractor need not (or& durin" any set !ours%
6% Contractor performs services for a particular 2o%
$7% Company s!all pay t!e Contractor 0)%68 of illale time t!e $-
and +7
of every mont! via c!ec& t!at (ill e
mailed to t!e Contractor9s address% :or any (or& t!at is illed and paid y t!e Company, ut t!en not paid y t!e ;tate of
Illinois, (ill e due ac& to t!e Company y t!e Contractor (it!in t(o calendar (ee&s from t!e date t!at t!e Company
notifies t!e Contractor via c!ec& or money order%
$$% Contractor s!all fa3 t!e Company an invoice t!e $7
and t!e )-
of eac! mont! detailin" patient9s name, EI numer,
type of service, place of service, and time spent servicin" t!e patient% T!e Contractor (ill not e paid for time spent aove
(!at !as een aut!ori<ed ased on t!e aut!ori<ations received y C!ild and :amily Connections%
$)% T!e Contractor s!all decide t!e time, place, manner, met!ods and order of (or&, includin" (!et!er t!e nature of t!e
(or&, t!is A"reement or local la( re4uires it to perform services durin" re"ular Company (or&in" !ours% T!e Company may
not c!an"e t!ese items or restrict Contractor to a specific territory%
$+% Company s!all not supervise Contractor, t!ou"! it may inspect (or& completed pursuant to t!is A"reement%
Contractor (ill (or& in a professional manner, !avin" represented t!at it !as necessary special s&ills to do t!is%
$,% T!e Contractor need not report to t!e Company in any (ay% ;umittin" ills and contactin" ot!er Contractors or t!e
Company, if necessary for Contractor, s!all not e reportin" for t!is purpose%
$-% Contractor need not meet a minimum 4uota% It (ill (or& for t!e time needed to do t!e (or&%
$0% Contractor may stop (or& at any time after providin" t!e Company (it! a +7 day (ritten notice%
$1% Company s!all not (it!!old any ta3es from Contractor, (!o s!all e liale for its o(n (it!!oldin" and ot!er
applicale ta3es%
$5% Company s!all not provide Contractor (it!, or reimurse for, !ospital, medical, usiness liaility or =or&er9s Comp%
Insurance, sic& or vacation pay, a (or& ve!icle, onuses, "as allo(ances, uniforms, special clot!in", pensions, etc% Contractor
need not (ear uniforms or special clot!in" (!ile doin" (or& for Company%
$6% Company s!all not supply Contractor (it! tools, or rent or lease tools, e4uipment or space to Contractor for (or&%
Contractor s!all provide and maintain tools, e4uipment, supplies or ot!er items needed% It is solely liale for loss, dama"e or
t!eft of its property% T!is includes stora"e at suc! locations, or in route to or from t!em%
)7% Contractor s!all provide all materials needed for t!e (or&% Company and Contractor s!all eac! pay t!eir o(n sales
ta3 on materials provided%
)$% T!e Contractor s!all not !ave &eys to t!e Company facilities%
))% A controversy or claim arisin" out of or relatin" to t!is A"reement, or t!e reac! t!ereof, may e settled y
aritration in accordance (it! American Aritration Association Rules, at t!e option of t!e party ma&in" a claim% T!e
prevailin" party may enter a 2ud"ment on t!e a(ard of t!e aritrators in any court !avin" 2urisdiction t!ereof% >ocal la(s, of
t!e place (!ere t!e Company si"ns t!is A"reement, s!all apply to it% ?earin"s s!all e at a location set y t!e Company%
)+% T!is A"reement and any attac!ments are t!e entire e3clusive a"reement et(een t!e Company and t!e Contractor%
Neit!er party s!all assi"n it (it!out (ritten permission% It inures to t!e enefit of t!e successors and assi"n of t!e parties%
T!e parties ma&e no e3press or implied representations, (arranties, promises or "uarantees aout t!is A"reement, e3cept as it
e3pressly provides% In t!e A"reement, t!e masculine includes t!e feminine and t!e sin"ular t!e plural%
Title# ********************* Date# ***********************

Address# ************************************************
Title# ********************** Date#************************
Address# ************************************************
ID@#*********************** P!one# ***********************