Supplier Registration Form

Please enter a company name.

Please enter an address.

Please enter a city.

Please enter a state.

Please enter a zip code.

Please enter a contact name.

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Thank you for submitting your registration. We will contact you as soon as possible.

Legal Terms of Registration The information provided is used to identify potential suppliers for contract opportunities. Please ensure that the information on your company is kept up-to-date. Registration does not guarantee any business enterprise the right to bid or receive a contract.

* Required Field

Detailed Description of product/services provided:

Have you worked with POWER Engineers before? YesNo

If yes, please provide the Contract Number:

How did you hear about POWER Engineers?

Name of POWER employee that referred you

Federal Programs (FAR Part 19 & 26)

Is your firm registered with the System for Award Management (SAM) or SBA's (DSBS) Dynamic Small Business Search?*YesNo

Has your firm completed Online Representation and Certifications Applications (ORCA) at SAM? YesNo

Is your firm a Small Business? YesNo

Is your firm a Small Disadvantaged Business?YesNo

Is your firm an 8(a) Small Disadvantaged Business*? YesNo

Is your firm a Woman-owned Small Business? YesNo

Is your firm a Veteran-owned Small Business? YesNo

Is your firm a Service-disabled Veteran-owned Small Business? YesNo

Is your firm a HUBZone Small Business*? YesNo

Is your firm an Alaskan Native Corporation or member of a recognized Indian Tribe? YesNo

*8(a) SDB and HUBZone must be certified by SBA

Unified Certification Programs (49 CFR 26)

Is your firm certified as a socially and economically Disadvantaged Business Enterprise (DBE) through a statewide Unified Certification Program (UCP)? List each UCP *YesNo

Certified As(Check all that apply): Minority Business Enterprise (MBE)Woman Business Enterprise (WBE)

State:

Certifying Agency or Organization:

Certification No.


State:

Certifying Agency or Organization:

Certification No.


State:

Certifying Agency or Organization:

Certification No.




Additional Certifications

Does your firm hold other certifications (including municipal, regional, and third party)? YesNo

* Including VBE and DSVBE certifications

Certification If other:

State/Council

Membership No.


Certification If other:

State/Council

Membership No.


Certification If other:

State/Council

Membership No.




Additional Information

Number of Employees at your firm

Average Annual Revenue

Year Established

Organization Classification If other




Under penalties of perjury, I certify that the information provided on this form is accurate and true to the best of my knowledge. (Pursuant to 15 U.S.C 645(d))

Contact supplierdiversity@powereng.com with questions or any additional information.