Please print form below and mail or fax copies to: CLEAR, 403 Marquis Ave, Ste. 100, Lexington, Kentucky 40502. Fax: (859)231-1943

CLEAR CONSULTING SERVICE (CCS) CONSULTANT AGREEMENT

 

I, ________________________________ , do agree to assist the Council on Licensure,

Enforcement and Regulation (CLEAR) by serving as a (state type of) ____________________ 

consultant to the _________________________ project for _____ days @ $300 per day.

 I specifically agree to provide the following services and products between the dates of

 ____________________ and ___________________________, in accordance with the

 attached documents and in exchange for satisfactory completion of which I will receive the

 per-day consultant fee and reimbursement of pre-approved expenses: (Examples of services and

 products to list : on-site visit, objectives and dates; specific report writing assignments)

 

Attachments List:

1.

2.

3.

4.

 

I understand that I will be reviewing or writing confidential material and do agree to NOT disclose

 its contents or to compromise its security in any way. I further agree that I have been engaged as

 an independent contractor and not as a representative of any organization I may otherwise

 represent. I will immediately notify CLEAR and remove myself from participation on this project

 should a breach of this agreement occur.

 

_____________________________ ________________________

Signature of Consultant                                     Date

 

Accepted by CLEAR:

 

_____________________________ ________________________

CLEAR Staff Project Director                             Date