Vendor/Contractor Information Packet

Vendor/Contractor Information Packet

We want your general business information, your Utah Retirement Systems (URS) Post-Employment Restrictions Certification and Release, your W-9 Form, and your Certificate of Insurance (COI)
General Business Information
Business Name
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What Industry is your business in?
Contact Name

First NameLast Name
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email
example@example.com
What department are you currently working with?
Utah Retirement Systems (URS) Post-Employment Restrictions Act Certification and Release
Lindon City is a URS participating agency. As a participating agency, post-retirement employment/vendor/contractor rules apply. Post-retirement means returning to work either on our payroll or as a vendor/contractor for a URS participating employer following your retirement date with the Utah Retirement Systems. Different standards apply depending on whether you return to work within one year or after one year from your retirement date with URS.

You must separate from employment (including part-time and vendor/contractor arrangements) with any participating employer for one year following your retirement date with URS, unless eligible exclusions apply.

You are responsible for understanding post-retirement employment rules and ensuring there is no violation of such rules by providing services to Lindon City. If you have any questions, call the URS office at 801-366-7770 or 800-695-4877 before you begin any work for or provide any services to Lindon City.
Are you a sole proprietor?
Are you a URS retiree?
How long have you been a URS retiree?
URS Retiree Name

First NameLast Name
Retiree Social Security Number
Contractor certifies that they are a Utah Retirement Systems (URS) retiree. Contractor further certifies that the URS office has been properly notified of post-retirement reemployment of this individual. Contractor assumes all responsibility for compliance with post-retirement reemployment restrictions, notifications,and/or penalties that may occur at any time in the future if found to be in violation.
Contractor certifies that he or she is not a Utah Retirement Systems (URS) retiree and acknowledges that should he/she retire from the URS system in the future, he/she assumes all responsibility for compliance with post-retirement reemployment restrictions, notifications, and/or penalties that may occur at any time in the future.
Signature
Date

MonthDayYear
Date
Required Forms
Please upload your W-9

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Please upload your Certificate of Insurance (COI)

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Should be Empty:

Vendor/Contractor Information Packet

General Business Information

Utah Retirement Systems (URS) Post-Employment Restrictions Act Certification and Release

Required Forms