SERVICE PROVIDER QUESTIONNAIRE (SPQ)
Revised: 03/01/06
Name of Business: ____________________________
Nature of Business: ___________________________
Vendor Banner ID: ___________________________
Banner Requisition Number: ________________________________________
Please answer the following questions about the proposed independent contractor and discuss your answers as appropriate. Attach additional sheets if necessary.
1. Is the proposed contractor a corporation? ___________If so, please provide tax identification number:________________________. If the proposed contractor is an individual, please provide the individual's U.S. social security number or individual tax identification number: ______ Is the person a foreign national? ______
2. Conflict of Interest: (See Section 3. of Policy 4325)
Does a UNM employee, an individual employed at UNM in the past twelve (12) months, a public and student member of an advisory board or committee, a UNM volunteer serving in an official capacity or any member of their immediate families have a direct or indirect financial interest in the independent contractor specified above? If yes, attach proof of compliance with "Conflicts of Interest" Policy 3720, UBP.
3. Please describe the nature of the service to be performed by the proposed contractor and how that service relates to the responsibilities of your department. A detailed scope of services must appear on the Purchase Requisition.
4. Is the proposed contractor going to be involved in completion of daily operations in your department? __________ Why or why not? _______________________________________
5. How long will the contractor be working on the project______________?
6. Will the contractor perform the services personally? ______ With other individuals? ______ Of those other individuals, whose employees are they? ________________________________
7. Will this project require full-time effort by the contractor personally? _________
8. Does the proposed contractor perform work for other clients and solicit work from other clients? _________ Please attach the proposed contractor's brochure or resume (if available.) Your central accounting office may require a brochure or resume to complete processing.
9. Is the proposed contractor listed in the business pages of the telephone directory? ______ Yellow pages? ______ Please attach photocopies of the listings.
If applicable, enter the contractor's NM gross receipts number _____________
10. Will your department specify: (if yes, please explain)
a. Where the work is performed?______________________________________________
b. What hours will be worked?________________________________________________
c. How the work is performed?________________________________________________
11. Does your department substantially control or have the right to substantially control the detailed method of work? ______ Result of work? ______ If yes, please explain. __________________________________________________________
12. Does your department provide the following things needed to perform the work? (if so, explain why):
a. Work space for the contractor? _______________________________________________
b. Tools and equipment (including office equipment)? _______________________________
c. Materials and supplies needed to perform the work? _______________________________
13. Does the University provide:
a. Training for the contractor? ______ If so, what type of training? _____________________
b. Other persons to assist in performing the work? ______ If so, whom? ________________
14. Will the University be paying expenses of the contractor? ______ If so, what type of expenses and what is the method of payment? ____________________________________
15. How is the proposed contractor to be paid -- a flat fee for the job, an hourly or daily rate for time spent on the project, or an amount per week or month? ___________________________
16. Has your department (or the University to your knowledge) used this contractor before? ______ Do you envision using this contractor again? ______ Please explain. _____________
_______________________________________________________________________
_______________________________________ ___________________ ____________
Signature of Person completing this Form ----------------- Phone # ------------- Date
_______________________________________________________________________
Printed Name of Person Completing this Form
__________________________________________________________ ____________
Signature of Department Head -------------------------------------------------- Date
_______________________________________________________________________
Printed Name of Department Head
________________________________________________________________________
Department Name and Org Code
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Central Accounting Office Use Only
Approved as Universal Service Provider ________________________________________________________
Approved one-time only for Requisition _________________________________________________________
Comments may be sent to UBPPM@UNM.edu
http://www.unm.edu/~ubppm