Surveillance Contractor Agreement

Full Name
(Legal Name - Must Match Driver's License & W9)

Company Name (if applicable)
(Legal Name - Must Match W9)

Phone

[honeypot honeypot-747]

Email

Address

Driver's License State and Number

Investigations License(s) with State, Number and Expiration.

Full Day Rate (Initial)
Full Day Flat Rate: $350.00/day – Flat rate is all inclusive to include 8 hours onsite surveillance, up to 2 hours travel or 120 miles, on the job mileage, report writing, video time & date stamp processing and delivery. Any hourly rates or overtime rates are calculated internally by the CONTRACTOR and agreed to.

Half Day Rate (Initial)
Half Day Flat Rate: $195.00/day – Half day flat rate is all inclusive to include 4 hours onsite surveillance, 2 hours travel or 120 miles, on the job mileage, report writing, video time & date stamp processing and delivery. Any hourly rates or overtime rates are calculated internally by the CONTRACTOR and agreed to.

Extended Hours (Initial)
Extended Surveillance Hours: $35.00 per hour after the 8 hour full day flat rate or 4 hour half day flat rate.

Excess Travel (Initial)
Excess Travel Time & Mileage: $35.00 per hour after 2 hour full day flat rate or 1 hour half day flat rate.

Excess Mileage (Initial)
$0.55 per mile after 120 miles full day flat rate or 60 miles half day flat rate .

Overtime/Excess Mileage Approval (Initial)
All overtime/extended hours and extra mileage must be pre-approved in writing.

Out-Of-Pocket Expenses (Initial)
Out of Pocket Expenses: Tolls, parking and miscellaneous expenses that are incurred during the course of the investigation will be invoiced at actual cost. CONTRACTOR will provide receipts for all reimbursed expenses. CONTRACTOR will not be reimbursed for expenses that are not accompanied by a receipt.

Contact Availability (Initial)
CONTRACTOR shall be accessible via cell phone and email during service hours.

Schedule (Initial)
Investigative efforts will commence on the date and time specified by the case manager.

Unapproved Research (Initial)
CONTRACTOR will not be paid for any unapproved background research.

Non-Solicit (Initial)
CONTRACTOR will not make direct contact with a known represented party or parties to a claim to include, physicians, insurance companies or claims adjusters/examiners without written consent.

Hourly Video (Initial)
CONTRACTOR will obtain hourly video time shots of the residence and/or surrounding area by video of the clock on a smartphone or tablet.

Active Subject (Initial)
CONTRACTOR shall maintain surveillance on an ‘active subject’ even if the authorized budget has expired and will immediately contact the case manager for approval of overtime.

One Investigator (Initial)
No more than one CONTRACTOR may work on an assignment without prior written approval.

Daily Updates (Initial)
CONTRACTOR will provide an update to the case manager each day at the 4 hour mark and at the end of the day before terminating the surveillance. Updates can be provided to the case manager via text or email.

PreText (Initial)
CONTRACTOR will not pretext to represent claimants without written permission.

Laws (Initial)
CONTRACTOR will obey all city, county, state and federal laws.

Reporting (Initial)
After each day of surveillance and no later than 8:00 am [Pacific Time] the next morning/following day [including weekends], CONTRACTOR will email a typed summary update to the case manager that includes the date of surveillance, the start and end times, a description of the activities observed and the amount of [claimant only] video.

Final Report (Initial)
CONTRACTOR will submit final a report on the provided template within 48 hours after the last day of surveillance. Reports will be emailed to the case manager.

Video Submission (Initial)
CONTRACTOR will upload or provide a download link of the time stamped video in WMV FORMAT within 48 hours after the last day of surveillance.

Invoice (Initial)
CONTRACTOR must submit an invoice for services rendered to the case manager within 48 hours after the last day of surveillance.

Invoice Details (Initial)
Invoice shall include the provided file number, claimant name, name of CONTRACTOR, time period covered by the invoice, and brief description of Services performed within the invoice.

Equipment (Yes/No)
The Contractor agrees to provide at his or her own expense the required equipment for the agreed scope of work, which may include but not limited to: a smartphone with data plan, a high quality video camera with zoom, a reliable means of transportation, a laptop computer, email, etc.

Agree to Nondisclosure and Confidentiality (Yes/No)
The Contractor agrees that [he or she] will not disclose any of the trade secrets, inventions, innovations, processes, information, records and specifications owned or licensed by the Company, directly or indirectly, or use any of them in any manner, either during the term of this Agreement or at any time thereafter, except as required in the course of this engagement with LaSorsa & Associates.

Eligibility to Enter Contract / Non-Hire Provision (Yes/No)
A positive response (Yes) is required to indicate you are eligible to enter a contract with LaSorsa and Associates, and not bound by any other contractual obligations or non-compete which would prevent you from being eligible to work for LaSorsa and Associates.

Understanding of Worker's Compensation Requirement (Yes/No)
The Contractor understands that the Company requires all contractors to have their own Worker's Compensation coverage and if they do not provide a certificate as instructed or the certificate is invalid or expired, the Company may withhold 3% of gross payments.

Please upload your investigations license(s)
Please label "(State) License - NAME"

Please upload your worker's comp insurance certificate (if applicable) (GL and WC are required for companies)
Please label "WC - NAME"

Please upload a completed and signed W9 (signature page only)
Download W9 Here: https://www.lasorsa.com/wp-content/uploads/2019/04/W9-form.pdf
Please label “W9 - NAME”

Signature (must be legible and match name above)
"My signature below confirms my agreement to the terms presented and to the temporary, 'at-will' contractor relationship between myself (the Contractor) and LaSorsa & Associates; I am to receive payment up to 30 days post invoice upon project completion with approved expenses reimbursed; I will not receive payment if I have not submitted an acceptable work product as described above; I must provide my own personal equipment; I have no claim to benefits such as sick or vacation pay or leave, health or disability benefits, unemployment insurance benefits, or employee benefits of any kind; I am subject to IRS Form 1099 and I must provide a W-9; I will indemnify and hold-harmless LaSorsa & Associates and its affiliates, officers, directors, employees, agents, successors and assigns from and against all losses, damages, liabilities, deficiencies, actions, judgments, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorneys' fees, arising out of or resulting from bodily injury, death or damage to real or tangible personal property resulting from acts or omissions as well as any breach of any representation, warranty or obligation under this Agreement; I accept the choice of law for any discrepancy, settlement or otherwise is the state of Florida."