Northville Parks and Recreation
INDEPENDENT CONTRACTOR PROGRAM PROPOSAL
For new contractors
Complete application and return to recreation@northvilletownshipmi.gov or mail to:
Northville Parks and Recreation | 16225 Beck Rd. | Northville, MI 48168
INSTRUCTOR INFORMATION
Name
*
First Name
Middle Initial
Last Name
Name of Business or Organization
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home or Business Phone #
*
Format: (000) 000-0000.
Cell #
*
Format: (000) 000-0000.
Fax #
Format: (000) 000-0000.
Email
*
example@example.com
Website
Social Media Handles
To whom should checks be payable?
*
Individual
Business
For tax purposes Only (submit upon program acceptance) Social Security or Tax ID #
PROGRAM DESCRIPTION
Proposed Program Title:
*
Program Description for Marketing Materials (including benefit statements and action language, 50 words maximum)
*
PROGRAM PREFERENCES
Do you have a preference of when to teach this program?
*
Weekdays
Weekday Evenings
Weekends
Day(s)/time(s) you prefer?
*
Day(s)/time(s) you cannot teach?
PROGRAM INFORMATION
Age Min.
*
Age Max.
*
Min. class enrollment
*
Max. class enrollment
*
Seasonal Program Y/N ? Identify Season:
*
Supply/Material Fee: (Payable to Instructor 1st class)
*
Items provided by instructor:
*
Special Room Requirements:
*
Rows
Days
Start/End Dates Preference
Start/End Times Preference
No Class Dates (i.e. Holidays)
# of Classes
Suggested program fee
Per class Fee
(office Use Only) Course Number
1
2
3
4
5
6
Back
Next
PROGRAM CATEGORY
PROGRAM SUB-CATEGORY
PROGRAM CATEGORY
*
50 North
Community & Special Events
Dog Park
Drop In
Health & Wellness
PROGRAM CATEGORY
*
Outdoor Recreation
Preschool
Theraputic Recreation
Volunteer
Youth & Teen
PROGRAM SUB-CATEGORY
*
Adult Fitness
Arts & Culture
Athletics
Cards & Games
Concert Series
PROGRAM SUB-CATEGORY
*
Enrichment
Family Fitness
Leagues
Luncheons
Open Activities
PROGRAM SUB-CATEGORY
*
Outdoor Enrichment
Recreation
Senior Fitness
Trips & Travel
Yoga/Yoga Fitness
INDEPENDENT CONTRACTOR REFERENCES
New Contactor: Please provide 3 references below.
Name
Phone
Format: (000) 000-0000.
Email
example@example.com
Name
Phone
Format: (000) 000-0000.
Email
example@example.com
Name
Phone
Format: (000) 000-0000.
Email
example@example.com
INDEPENDENT CONTRACTOR INFORMATION
Please list your experience and qualifications:
Please provide a Bio: Skills, certifications, accomplishments, etc. as they pertain to the program you are instucting. A headshot or preferred picture will also be required upon program approval. This information may be used in marketing materials including social media. (50 words maximum)
INDEPENDENT CONTRACTOR REQUIREMENTS
Contractor agrees to communicate all program needs, pricing, schedules, and logistics in accordance with Department deadlines and protocols; request a list of registered participants prior to the first session; maintain accurate attendance records and submit them to the Department upon course completion as requested; report any accidents or incidents occurring during a course and submit written documentation within 24 hours (with documentation completed by a Township employee); and contact the Department regarding all cancellations and incidents/accidents. Parks and Recreation staff and the Contractor will mutually agree on procedures for notifying enrollees of any cancellations. The Contractor shall take responsibility for the supervision of participants and the reasonable care of all facilities used, including exercising due diligence in the handling, securing, and return of Department equipment, ensuring receipts are signed upon return. If the Contractor is unable to conduct a scheduled course or program (providing at least 24-hour notice when possible), one of the following protocols will apply: no makeup session with participants receiving a prorated refund; a makeup session scheduled at the earliest mutual availability; or arrangements made for a qualified substitute instructor (with the Contractor responsible for required background checks). The Contractor further agrees to complete a program evaluation form upon course completion; comply with all Department policies and procedures; successfully complete a Northville Township criminal background investigation and ensure the same for all staff involved in Department programs; assume all responsibility and liability for assigned staff and volunteers; sign the contract and hold harmless agreement annually; and procure and maintain insurance as required under Section 13 of the Independent Contractor Contract Agreement.
COMPENSATION INFORMATION
Contractor will be paid within thirty days of the completion of the program as long as all appropriate paperwork has been submitted. Contractor will be required to submit an accurate invoice within 30 days of each program/session completion. If compensation is based upon facility charges, they will be calculated based on a designated percentage of the current rental rate at the time of the signed Addendum. If compensation is based upon the number of persons being instructed or supervised, only those persons on the official roster provided by the Department shall be counted for this calculation. Contractor compensation rates are based on the resident rate only, regardless of a participant's residency status.
APPLICANT SIGNATURE
By signing, applicant has reviewed and agrees to terms set forth in this application.
Signature
Date Signed
-
Month
-
Day
Year
Date
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