Laserfiche WebLink
STATE OF HAWAII <br />CERTIFICATE OF EXEMPTION <br />FROM CIVIL SERVICE <br />Attachment — S4 <br />1. By Heads of Departments Delegated by the Director of the Department of Human Resources <br />Development ( "DHRD ").* <br />Pursuant to a delegation of the authority by the Director of DHRD, I certify that the services to <br />be provided under this Contract, and the person(s) providing the services under this Contract are exempt <br />from the civil service, pursuant to § 76 -16, Hawaii Revised Statutes (HRS). <br />(Signature) <br />Loretta J. Fuddy, A.C.S.W, M.P.H. <br />(Print Name) <br />Director of Health <br />(Print Title) <br />(Date) <br />* This part of the form may be used by all department heads and the heads of attached agencies to whom the Director <br />of DHRD expressly has delegated authority to certify § 76 -16, HRS, civil service exemptions. The specific paragraph(s) of <br />§ 76 -16, HRS, upon which an exemption is based should be noted in the contract file. If an exemption is based on <br />§ 76- 16(b)(15), the contract must meet the following conditions: <br />(1) It involves the delivery of completed work or product by or during a specific time; <br />(2) There is no employee - employer relationship; and <br />(3) The authorized funding for the service is from other than the "A" or personal services cost element. <br />NOTE: Not all attached agencies have received a delegation under § 76- 16(b)(15). If in doubt, attached agencies should <br />check with the Director of DHRD prior to certifying an exemption under § 76- 16(b)(15). Authority to certify exemptions <br />under § §76- 16(b)(2), and 76- 16(b)(12), HRS, has not been delegated; only the Director of DHRD may certify §§ 76- 16(b)(2), <br />and <br />76- 16(b)(12) exemptions. <br />2. By the Director of DHRD, State of Hawaii. <br />I certify that the services to be provided under this Contract, and the person(s) providing the <br />services under this Contract are exempt from the civil service, pursuant to §76 -16, HRS. <br />(Signature) (Date) <br />(Print Name) <br />(Print Title, if designee of the Director of DHRD) <br />ADM. SERV. OFFICE <br />AG -014 Rev 6/26/2006 LOG NO . 12 - 0 4 4 <br />1 <br />