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  Vendor Application Form  
 
We appreciate your assistance in furnishing the following information so that we may enter your company into our Vendor File. This allows us to consider you as a source of supply for future purchases.

"In addition to other laws which may be applicable, section 16(d) of the Small Business Act, 15 U.S.C. 645(d), provides severe criminal penalties for knowingly misrepresenting the small business size status of a concern in connection with procurement programs. Section 16(a) of the Act also provides, in part, for criminal penalties for knowingly making false statements or misrepresentations to SBA for the purpose of influencing in any way the actions of the Agency."
( * = required fields)
Primary Address
 
* Company Name
DBA
* Address
* City
* State
* Zip Code
* Name of Primary Point of Contact
E-Mail Address
* Telephone Number
Fax Number
Alternate POC
Alt. Telephone Number
 
Tax and Identification Data
IRS Form 1099-MISC Needed? Yes No
*DUNS Number
*North American Industry Classification System (NAICS)
CAGE Code
URL
Date Org. Established

Debarment/Suspension Status

Type of Business Organization
Corporation
 
 
Small Business Classification *
 
 
Remit Payment Address
 
* Company Name
DBA
* Address
* City
* State
* Zip Code
* Name of Primary Point of Contact
E-Mail Address
* Telephone Number
Fax Number
Alternate POC
Alt. Telephone Number
 
General Capabilities Statement
 
Special Capabilities Statement
 
Vendor Representation
 
Past 36 Month USG Contracts (Title / #)

 
Past 36 Month Commercial Relevant Contracts
 



Socioeconomic Definitions


"Historically Black College or University"
means an institution determined by the Secretary of Education to meet the requirements of 34 CFR 608.2.

"HUBZone Small Business"
means a small business concern that appears on the List of Qualified Historically Underutilized Business Zone (HUBZone) Small Business Concerns maintained by the Small Business Administration. This list is available on the SBA's website at
http://www.sba.gov/hubzone.

"Minority Institution"
means an institution of higher education meeting the requirements of Section 1046(3) of the Higher Education Act of 1965 (20 U.S.C. 1135d-5(3)) which, for purposes of this definition, includes a Hispanic-serving institution of higher education as defined in Section 316(b)(1) of the Act (20 U.S.C. 1059c(b)(1)).

"Service-Disabled Veteran-Owned Small Business"
means a small business concern that --

(1) Is not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(2) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran. "Service-disabled veteran" means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).

"Small Disadvantaged Business"
means an offeror that represents that it is a small business and either --

(1) It has received certification as a small disadvantaged business concern consistent with 13 CFR part 124, subpart B; and

     (a) No material change in disadvantaged ownership and control has occurred since its       certification;

     (b) Where the concern is owned by one or more disadvantaged individuals, the net worth      of each individual upon whom the certification is based does not exceed $750,000 after      taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

     (c) It is identified, on the date of its representation, as a certified small disadvantaged      business (SDB) concern in the database maintained by the Small Business      Administration at http://www.pro-net.sba.gov;

or

(2) For a prime contractor, it has submitted a completed application to the Small Business Administration or a private certifier to be certified as a small disadvantaged business concern in accordance with 13 CFR part 124, subpart B, and a decision on that application is pending, and that no material change in disadvantaged ownership and control has occurred since it submitted its application. In this case, a contractor must receive certification as an SDB by the SBA prior to contract award.

"Small Business"
means any concern that --

(1) In connection with subcontracts of $10,000 or less has a number of employees, including its affiliates, that does not exceed 500 persons; and
(2) In connection with subcontracts exceeding $10,000, has a number of employees or average annual receipts, including its affiliates, that does not exceed the size standard in 13 CFR Part 121 for the product or service it is providing on the subcontract. These size standards are available on the SBA's website at http://www.sba.gov/size.

"Veteran-Owned Small Business"
means a small business concern --

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more veterans.

"Women-Owned Small Business"
means a small business concern --

(1) Which is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and

(2) Whose management and daily business operations are controlled by one or more women.

 
     
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