System for Award Management

Transcription

1 System for Award Management Registering in SAM Core Data DUNS Information DUNS Number: Legal Business Name : Doing Business As (DBA Name): (Not needed if same as Legal Business Name) Physical Address: City: State: Zip/Postal Code: Zip Plus 4: The Physical Address cannot be edited in SAM. This information will be automatically populated by D&B and must match. To change/confirm this information registrants must use the iupdate system Business Information Business Start Date (mm/dd/yyyy): Fiscal Year Close Date (mm/dd): Marketing Partner ID (MPIN): The MPIN is created by client Must be 9 alpha-numeric, no spaces, no symbols Mailing Address: Check if same as physical address Mailing Address (PO Box is acceptable): City (M):_ State: Zip/Postal Code Tax Identification Number (TIN): TIN Type: EIN SSN : 1 P a g e

2 IRS Consent Taxpayer Name: Would you like to use: Physical address Tax Year (Most Recent): Name of Individual Executing Consent:_ Title of Individual Executing Consent:_ OR Mailing address Signature (MPIN): CAGE or NCAGE Code Does your entity already have a CAGE Code: If you had a CCR you do have a CAGE. If you did not have a CCR you do not have a CAGE and one will be assigned. Yes CAGE:_ No General Information Incorporation State of Incorporation: Country of Incorporation: United States Is your business/organization one of the following (if none are applicable, select Not Applicable from the drop-down menu)? Foreign Owned and Located Small Agricultural Cooperative Limited Liability Company Subchapter S Corporation Manufacturer of Goods Please indicate the form of your Business or Organization as Defined by the IRS: Corporate Entity, Not Tax Exempt Corporate Entity, Tax Exempt Partnership or Limited Liability Partnership Sole Proprietorship International Organization Other What is your organization's profit structure? For Profit Organization Non Profit Organization Other Not for Profit Organization 2 P a g e

3 Socio-Economic Categories: Veteran Owned Service Disabled Veteran Owned Women Owned Joint Venture Women-Owned Small Business Joint Venture Economically Disadvantaged Women-Owned Small Business Community Development Corporation Owned Firm Minority Owned (must also choose one specific type) Asian- Pacific American Owned Subcontinent Asian (Asian- Indian) American Owned Black American Owned Hispanic American Owned Native American Owned Other than one of the preceding Financial Information Financial Institution Name: This field will be automatically filled by providing the routing number) ABA Routing Number (9 digits): Account Number:_ Checking OR Saving ACH U.S. Phone Number: Automatic Clearing House (ACH = Bank) (M) at least one method of contact below must be entered (Note: ACH phone number can be the phone number of the local branch you bank at. Only one method of contact is required, so include either a phone number or a fax number to your bank.) Remittance Address Business Name: Address: City:_ State : Zip/Postal Code : Executive Compensation: In your business or organization s previous fiscal year, did your business or organization receive both of the following: percent or more of your annual gross revenues in U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements AND 3 P a g e

4 2. $25,000,000 or more in annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements Mandatory if answered yes to previous question: Does the public have access to information about the compensation of the senior executives in your business or organization or organization through periodic reports filed under section 12(a) or 15(d) of the Securities Exchange Act of 1934 or section 6104 of the Internal Revenue Code of Mandatory if answered yes to previous question: Provide the names, position titles, and total compensation amounts for the five most highly compensated executives in your business or organization. Proceedings: Is there a Federal solicitation on which your business or organization, as represented by the DUNS number on this specific SAM record, is bidding that contains the FAR provision , or has your business or organization, as represented by the DUNS number on this specific SAM record, been awarded a Federal contract that contains FAR clause ? Not applicable if answered No to previous question: Does your business or organization, as represented by the DUNS number on this specific SAM record, have current active Federal contracts and/or grants with total value (including any exercised/unexercised options) greater than $10,000,000? Not applicable if answered No to previous question: Within the last five years, had the business or organization (represented by the DUNS number on this specific SAM record) and/or any of its principals, in connection with the award to or performance by the business or organization of a Federal contract or grant, been the subject of a Federal or State 1. Criminal proceeding resulting in a conviction or other acknowledgment of fault; 2. Civil proceeding resulting in a finding of fault with a monetary fine, penalty, reimbursement, restitution, and/or damages greater than $5,000, or other acknowledgment of fault; and/or 3. Administrative proceeding resulting in a finding of fault with either a monetary fine or penalty greater than $5,000 or reimbursement, restitution, or damages greater than $100,000, or other acknowledgment of fault? Yes No 4 P a g e

5 Assertions Goods and Services: NAICS Codes: North American Industrial Classification Code to identify what products or service your business provides ( 6 digit numeric). Search on Only one NAICS code is required. Size Metrics Total Receipts (3 year average): Average Number of Employees (12 month average): EDI Information Do you wish to enter EDI Information for your non-government entity? Disaster Relief Do you wish to enter Disaster Relief Data for your entity? Yes No 5 P a g e

6 Points of Contact Government Business Point of Contact Name: Address: City: State: Zip/Postal Code: U.S. Phone: Ext: Non U.S.: Ext: Fax (U.S. Only): Accounts Receivable Point of Contact Name (M): (M): U.S. Phone: Ext: Non U.S.: Ext: Fax (U.S. Only): Electronic Business Primary Point of Contact Name: Address: City: State: Zip/Postal Code: U.S. Phone: Ext: Non U.S.: Ext: Fax (U.S. Only): 6 P a g e