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Independent Contractor Agreement

* READ FIRST *

  • Please note that if the entire form is not completed correctly, an entirely new form must be completed.
  • Please ensure all signatures are legible and name must match your driver’s license.
  • Please first properly label the required documents for upload below:
  • All attachments below must be a pdf|doc|docx|png|jpg|jpeg|heic and less than 3mb. (how to reduce file size?)
    • Applicable license: license of the company or qualifying agent, etc.
      • Please label “(State) License – NAME”
    • General Liability Certificate of Insurance (COI)
      • Please label “GL – NAME”
    • Workers Compensation Certificate of Insurance (COI)
      • Please label “WC – NAME”
    • Complete and sign these documents for upload below:
    • Complete a Payment Preference Form
  • When you click ‘SUBMIT FORM’ a confirmation box will appear. Anything else other than a confirmation is an error message, one or more fields have an error. Please check and try again.

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    Company Name

    *Your Full Legal Name

    *Your Phone

    *Your Email

    *Your Address

    *License(s) (State, Number and Expiration Date)

    *Agree to Duties and Terms. (Yes / No)
    The Independent Contractor’s duties, term of engagement, and provisions for payment thereof shall be as set forth an estimate provided to Executive Support and Logistics by the Independent Contractor or which is otherwise provided by Executive Support and Logistics and mutually agreed to by the Independent Contractor. The term is considered "at will" with no expectation or implied obligation of length of or from the Company to the Independent Contractor.

    *Eligibility to Enter Contract / Non-Hire Provision (Yes / No)
    A positive response (Yes) is required to indicate you are eligible to enter a contract with Executive Support and Logistics, and not bound by any other contractual obligations or non-compete which would prevent you from being eligible to work for Executive Support and Logistics.

    *Please upload a copy of your applicable License

    *Please upload your completed SubContractor Services Agreement
    Please label "SSA - NAME" (SubContractor Services Agreement form is linked above)

    *Please upload your completed Non-Disclosure Agreement
    Please label "NDA - NAME" (Non-Disclosure Agreement form is linked above)

    *Please upload your completed W9
    Please label "W9 - NAME" (W9 form is linked above)

    Please upload a copy of your General Liability Insurance COI

    Please upload a copy of your Worker’s Comp Insurance COI

    *Signature
    "My signature below confirms my agreement to the terms presented and to the temporary, 'at-will' independent contractor relationship between myself (the Independent Contractor) and Executive Support and Logistics; I am to receive payment up to 60 days post invoice upon project completion with approved expenses reimbursed; I must provide my own personal equipment; I have no claim to benefits such as sick or vacation pay or leave, worker’s compensation, health or disability benefits, unemployment insurance benefits, or employee benefits of any kind; I am subject to IRS Form 1099 and I must provide a W-9; I will indemnify and hold-harmless Executive Support and Logistics and its affiliates, officers, directors, employees, agents, successors and assigns from and against all losses, damages, liabilities, deficiencies, actions, judgments, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorneys' fees, arising out of or resulting from bodily injury, death or damage to real or tangible personal property resulting from acts or omissions as well as any breach of any representation, warranty or obligation under this Agreement; I accept the choice of law for any discrepancy, settlement or otherwise is the state of Georgia."

    Please Sign legibly within the box below (use the clear button to refresh only this section)



    Click once to submit- wait for confirmation