PMM Vendor Form

VENDOR REGISTRATION
Complete and submit this form using the "Submit Vendor Registration" button on the last screen (Certify & Submit tab).
Procurement and Materials Management Contractors: This is the registration database/process for contractors, vendors, and suppliers to CHPRC, MSA, WRPS and FH.

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Login... Enter either your Vendor No. or Email and your Vendor Key.

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Vendor Key:

Forgot your Vendor Key or Vendor No? Click the link below to have it sent to you via Email.

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New Vendor Registration

All contractors, vendors, and suppliers to CHPRC, MSA, WRPS or FH must register to use this system.

Please review the "Vendor Registration Information" prior to registering.

Use the button below to access the Vendor Registration Form.

SECTION F TAX STATUS

(Choose one status and complete the associated boxes)

Form W-9

Taxpayer Identification Number Request

Please complete the following information. We are required by law to obtain this information from you when making a reportable payment to you. If you do not provide us with this information, your payments may be subject to a 30% federal income tax backup withholding. Also if you do not provide us with this information, you may be subject to a $50 penalty imposed by the Internal Revenue Service under section 6723.

Use this form only if you are a U.S. person (including U.S. resident alien). If you are a foreign person, use the appropriate Form W-8.

Individual/Sole Proprietor: A sole proprietorship may have a trade name (doing business as), but the legal name is the name of the business owner.

	Business or Trade Name:
	Business Owner's Name: (if different)
	Business Employer Identification Number:	Do not use your social security number. You can get more information in a popup without leaving this form.

Partnership: A Partnership may have a trade name (doing business as), but the legal name is the list of the names of the partners.

	Name of Partnership:
	Partnership's Employer Identification Number:
	Partnership's Legal Name (Name of First Partner):

Limited Liability Company (LLC)

	Name of LLC:
	Employer Identification Number:

Corporation, exempt charity, or other entity: A corporation may use an abbreviated name, but the legal name is the name on the articles of incorporation.

	Name of Corporation or Entity:
	Employer Identification Number:
	Are you exempt from Form 1099 reporting? Yes No
	If you are exempt from Form 1099 reporting, please choose one:

WRPS Representations and Certifications: Required by Vendors doing business with WRPS ONLY					Need help with this form?	Help
Incomplete Reps & Certs for NAICS: Completed Reps & Certs For NAICS: Representations & Certifications Rev. D 03.26.07 WRPS is performing this work under a Federal prime contract. This prime contract requires WRPS to obtain certain information and certifications from your company. You are required to thoroughly read and understand this form and submit electronically to WRPS. The Representations and Certifications shall be submitted by an individual authorized to commit your company. An award to your company cannot be made until this document is completed and submitted to WRPS for the applicable North American Industrial Classification Code (NAICS). The offeror represents and certifies as part of its offer that: 1. Small Business Program Representations (FAR 52.219-1, modified) (October 2001) Based on the NAICS code for this certification, The Subcontractor’s business is classified by Small Business Administration standards as: Large Other (identify specific classification below) If Other classification (selected above) identify here. Subcontractor agrees to submit and maintain an accurate Vendor Registration Form (www.hanford.gov/chgcp/) including Subcontractor’s proper legal name, tax status and business description as defined by the Small Business Administration (www.sba.gov) and in the federal Small Business Act (P.L. 85-536). 2. Previous Contracts and Compliance Reports (FAR 52.222-22) (Feb 1999) Subcontractor complies with all requirements of federal and State of Washington statutes, ordinances, rules and regulations, codes, and orders related to equal employment opportunity and operation of non-segregated facilities 3. Affirmative Action Compliance (FAR 52.222-25) (Apr 1984) Subcontractor complies with all applicable reporting and affirmative action program requirements of federal Executive Order (E.O.)11246 and the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2). 4. Certification Regarding Debarment, Suspension, Proposed Debarment, and Other Responsibility Matters (FAR 52.209-5) (Jan 2001) Neither Subcontractor nor any of its principals: (a) are presently debarred, suspended, proposed for debarment, or ineligible for the award of contracts by any federal agency; (b) have, within a 3-year period preceding this date, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, State, or local government) contract or subcontract; been in violation of federal or state antitrust statutes relating to the submission of offers; or been convicted of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; or been indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in (b) above. 5. Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. (FAR 52.203-11) (Apr 1991) No person or company, other than Subcontractor's employee(s) or affiliate firms, has/have been paid to solicit or obtain a Subcontract nor has any agreement been made to pay a person or company a commission, fee, or any form of compensation contingent upon award of a Subcontract. 6. Certification of Toxic Chemical Release Reporting (FAR 52.223-13) (Oct 2000) Any facility utilized in the performance of an awarded Subcontract has not been listed on the Environmental Protection Agency List of Violating Facilities as provided in the Federal Clean Air Act, or Clean Water Act, as respectively amended. 7. Certification of Anti-Kickback (FAR 52.203-7) (July 1995) Subcontractor certifies that it has not (a) provided, attempted or offered to provide; (b) solicited, accepted or attempted to accept; or (c) included, directly or indirectly, the amount of any kickback as defined by 41 U.S.C. Sections U51-58 with respect to this action. 8. Certification of Buy American Act Compliance Subcontractor certifies that only domestic end products will be proposed unless otherwise specifically identified, in accordance with the Buy American Act 41 U.S.C. 10 as amended and the Federal Acquisition Regulations (FAR), in the Subcontractors proposal(s). 9. Certification of Independent Pricing Subcontractor prices have been arrived at independently, and without consultation, communication, agreement, or condition that relates to this action by any other Subcontractor or competitor in violation of antitrust or fair trade/anti-competitive laws. The Subcontractor has not, and shall not, disclose offered prices to any other Subcontractor or competitor prior to award of a resulting contract or cancellation of a solicitation. Subcontractor has not attempted to induce any other person or firm to submit, or not submit, an offer in response to this action. Subcontractor warrants that the prices offered do not exceed those currently offered to any other customer for the same or similar quantities of the same or similar goods or services which includes any future pricing modifications. SUBMISSION CERTIFICATION By submitting this form, the Subcontractor certifies, under penalty of law, it has the independent authority to enter into a binding agreement or Subcontract with WRPS without any restrictions from another business entity or parent company. If otherwise, Subcontractor must identify the parent company or controlling entity. The Subcontractor certifies that the above certifications are accurate, current and complete. The Subcontractor further certifies that it will notify WRPS of any changes to these certifications. The certifications made by the Subcontractor, as contained herein, concern matters within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent representation or certification may render the maker subject to prosecution under Title 18, United States Code, Section 1001 EXCEPTION(S) TO CERTIFICATIONS An exception to any certification above will not necessarily result in withholding of an award. However, the certification will be considered in connection with a determination of the Subcontractors responsibility. Subcontractor shall list any exceptions to the above certifications in the following space provided: Name of Person responsible for submission of this form: Title of Responsible Person: Name of Organization:

Vendor Registration Information

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Representations & Certifications Rev. D 03.26.07