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Master Contract No.902012 <br />Procurement Contract No. 24823 <br /> <br /> <br />4. Is the relationship between the County and the contractor intended to be <br />ongoing? <br />( ) ( ) <br />III. FOR CONSULTANTS, PROJECT MANAGERS, PROJECT COORDINATORS YES NO <br />1. Is the contractor being hired for a period of time rather than for a specific <br />project? <br />( ) ( ) <br />2. Will payment be based on a wage or salary (as opposed to a commission or ( ) ( ) <br /> lump sum)? <br />IV. FOR PHYSICIANS, PSYCHIATRISTS, DENTISTS, PSYCHOLOGISTS YES NO <br />1. Will the agreement be with an individual who does not have an outside <br />practice? <br />( ) ( ) <br />2. Will the contractor work more than an average of ten hours per week? <br />IF THE ANSWER TO QUESTION 2 IS YES, ANSWER QUESTION 3. <br />( ) ( ) <br />3. Will the County provide more than 20% of the contractor’s income? ( ) ( ) <br />4. If the answer to either question 2, or if required, question 3 is NO, the entire <br />answer is NO. <br /> <br /> <br />A “YES” answer to any of the questions in Section II, or, if applicable, Sections III or IV constitutes <br />justification for paying the contractor through the payroll system as an “employee for withholding <br />purposes.” <br /> <br />CERTIFICATIONS: <br /> <br />I hereby certify that the answers to the above questions accurately reflect the anticipated working <br />relationship for this contract. <br /> <br /> City Manager, <br />City of San Leandro <br />Director, Health Care Services Agency <br /> <br /> Fran Robustelli Colleen Chawla <br />Printed Name Printed Name <br /> <br />2/2/2023 <br /> <br />Date Date <br /> <br /> <br />Page 2 of 2 <br />2/14/2023