HomeMy WebLinkAboutPS23-1756_Sally Ruth Elam_dba Sally Goldberg, Ph. D.Town of Fountain Hills Contract for Individual Services
Date: _________ Description of Service: __________________________________
It is agreed by and between the Town of Fountain Hills, Arizona, hereinafter referred to as “Town” and
_________________________________________ hereinafter referred to as “Contractor,” that Contractor agrees to perform the
Services defined below for the Town, and the Town agrees to pay the Contractor for the Services.
1.Contractor who will be providing the Service:
Taxpayer Name (as shown on your tax returns): ____________________________________
Instructor’s Name (if different from taxpayer): _______________________________Date of Birth __________
Address __________________________________________ City:_____________ State: _____Zip:___________
Primary Phone: _____________________________ Email:___________________________________________
W-9 Submitted ____
FOR TOWN USE ONLY: Vendor #:____________ ORG _______________ OBJ:__________
2.Contractor who will be providing the Service:
•Coordinate and instruct assigned recreation classes.
•Provide safety instructions and guidelines to all participants.
•Arrive 15 minutes prior to the start of class.
•Provide information and materials to participants for activity.
•All registrations will be taken by the Town of Fountain Hills Community Services. Instructors cannot collect any fees
onsite. The Town does not pro-rate registration fees or refunds.
•Instructor must notify Recreation Coordinator of any changes.
•Submit proposed program schedules to the Recreation Coordinator by January 10th, May 10th, and September
10th.
•Instructor is responsible for contact participants for make-ups and informing them if there isn’t class.
•Report customer feedback and suggested improvements about programs and facility to Community Services.
•Distribute and collect program survey/return to Town Hall.
3.Term and hours of Services:
Beginning Date: _________________ Ending Date: ________________ Class Length/Hours: _________________ Frequency/
Days per Week: ______________________
4.Class Size (Min/Max): ____________________
5.Facility or Location where the services will be provided: _____________________________________________
6.Payment:
The Town shall pay ____________ of the net revenue for the Services rendered.
Payment shall be made upon completion of the Services*
Town Policy: Invoices must be received by accounts payable at least 10 days before payment date. Check runs are done weekly on
Wednesdays.
By executing this Contract, the person signing below agrees, on behalf of the Contractor, (i) he/she has read the Town’s Standard Terms and
Conditions, dated April 14, 2016, as set forth on the Town of Fountain Hills website (www.fh.az.gov/po-terms), which are incorporated into and
become a part of this Contract as if set forth fully herein, and (ii) he/she has the authority to bind the Contractor and by executing this Contract has
entered into a binding agreement that includes the Standard Terms and Conditions, dated April 14, 2016.
________________________________________
Recreation Coordinator: Skylar Thomas
________________________________________
Town Manager: Grady Miller
________________________________________
Town Clerk: Linda Mendenhall
________________________________________
Instructor Signature: Sally Goldberg, Ph. D.
________________________________________
Department Director: Rachael Goodwinn
10/10/2022 Wellness and Parenting Programs
Sally Goldberg
Sally Elam
Sally Goldberg, Ph. D.04/23/1947
13302 N. Manzanita Lane AZ 85268
480-766-6323 drsallyinarizona@gmail.com
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1756 PRSPINT 6405
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Fountain Hills Community Center or Online
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Fountain Hills
Sally Goldberg, Ph.D. (Oct 19, 2022 16:32 PDT)
Rachael Goodwin (Oct 20, 2022 16:45 PDT)
Rachael Goodwin