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ACKNOWLEDGMENT OF INDEPENDENT CONTRACTOR STATUS

 

I am a self-employed independent contractor.

As a self employed independent contractor I understand I am in business for myself and obtain a salary from the
funds I received under the contract(s) with my client(s). I understand that I am not an employee of the Company
and it is not responsible for paying my salary and appropriate withholding of Federal, State, County, and City
taxes or paying Social Security, Workers’ Compensation, State Disability and Unemployment, or for providing
any benefits on my behalf of my spouse or dependents, including those that may be legally required. As a selfemployed
independent contractor, such obligations and responsibilities are my own.

I also expressly acknowledge and agree that because I am not an employee of the Company, I am not entitled or
eligible to participate in any of the Company’s employee benefit programs (neither is my spouse nor any
dependents). I hereby waive all rights to such benefits, including any right to file a claim for any employee
benefits under the Employee Retirement Income Security Act, applicable state or local law, or under any
company policy, practice, procedure, or program.


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