BUSINESS INFORMATION

The supplier, by checking the appropriate box(es), represents that –

Section I
  1. North American Industrial Classification System (NAICS) Code (FAR 19.102)

Enter the 6 digit NAICS Code that most closely represents the product, commodity or service that your firm is likely to sell to Allison Transmission in the calendar year covered by these representations.

NAICS Code:

The NAIC Code listings can be found at:

B.Tax Information
TIN (Tax Identification Number):
D&B Number:
Cage/ FSCM Number:

W-9 FORM – SUPPLIER MUST ATTACH COPY

C. Quality System:

Expiration Date
ISO 9000 / Yes / No
QS 9000 / Yes / No
TS 16949 / Yes / No
PLEASE ATTACH COPY OF CERTIFICATE(S)
D. Business Type:

It operates as:

United States (US) EntityForeign Entity

It operates as:

a corporation a partnership

an individual a joint venture.

a nonprofit organization

E.Labor Union Affiliation Representation

Supplier certifies that it HAS A HAS NO union affiliation(s).

Union Name 1
Contract Expiration
Union Local Number (if any)
Union Name 2
Contract Expiration
Union Local Number (if any)

(Please attach an additional page if more union information needs to be reported.)

Section I

F.Certification of Business Size

Government statues require periodic review of our files to ensure that we have correctly recorded our suppliers’ self-certification of business size, status and compliance with socioeconomic programs. Should you need assistance in determining your status in any of these categories listed below, please call the US Small Business Administration (SBA) office serving your area or reference there website:

  • Size of business categorized as:Large BusinessSmall Business

A Small Business Concern is: a concern, including its affiliates, that is independently owned and operated not dominate in the field of operation in which it is bidding on government contracts, and qualified as a small business under the criteria and size standards in 13 CFR Part 121 (see FAR 19.102).

Check the category (only one) that applies:

LA / Large, African-American Male / SA / Small, African-American Male
LB / Large, African-American Female / SAV / Small, African-American Male Veteran
LC / Large, Native American Male / SAD / Small, African-American Male Disabled Veteran
LD / Large, Native American Female / SB / Small, African-American Female
LE / Large, Hispanic Male / SBV / Small, African-American Female Veteran
LF / Large, Hispanic Female / SBD / Small, African-American Female Disabled Veteran
LG / Large, Asian Pacific Male / SC / Small, Native American Male
LH / Large, Asian Pacific Female / SCV / Small, Native American Male Veteran
LI / Large, Asian Indian Male / SCD / Small, Native American Male Disabled Veteran
LJ / Large, Asian Indian Female / SD / Small, Native American Female
LN / Large, non-Disadvantaged Male / SDV / Small, Native American Female Veteran
LW / Large, non-Disadvantaged Female / SDD / Small, Native American Female Disabled Veteran
LAN / Large Alaska Native Corp & Indian Tribes / SE / Small, Hispanic Male
SN / Small, non-Disadvantaged Male / SEV / Small, Hispanic Male Veteran
SNV / Small, non-Disadvantaged Male, Veteran Owned / SED / Small, Hispanic Male Disabled Veteran
SND / Small, Service Disabled Veteran Owned / SF / Small, Hispanic Female
SW / Small, non-Disadvantaged Female / SFV / Small, Hispanic Female Veteran
SWV / Small, non-Disadvantaged Female Veteran / SFD / Small, Hispanic Female Disabled Veteran
SWD / Small, non-Disadvantaged Female Disabled Veteran / SG / Small, Asian Pacific Male
SAN / Small Alaska Native Corp & Indian Tribes Certified / SGV / Small, Asian Pacific Male Veteran
SP / Small, Indian-Owned Econ Enterprise Certified / SGD / Small, Asian Pacific Male Disabled Veteran
ST / Natl. Indust. for the Blind / Sev Handic / SH / Small, Asian Pacific Female
SM / Hub Zone Enterprise / SHV / Small, Asian Pacific Female Veteran
SO / HBCUand Minority Institutions (MI) / SHD / Small, Asian Pacific Female Disabled Veteran
SI / Small, Asian Indian Male
SIV / Small, Asian Indian Male Veteran
SID / Small, Asian Indian Male Disabled Veteran
SJ / Small, Asian Indian Female
SJV / Small, Asian Indian Female Veteran
SJD / Small, Asian Indian Female Disabled Veteran

Section II:

  • Veteran-Owned Small Business Concern:

A Veteran-Owned Small Business Concern - (1) not less than 51% of which is owned by one or more veterans (as identified at 38 U.S.C. 101 (2) or, in the case of any publicly owned business, not less than 51% 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. (FAC 97-20)

  • Service-Disabled Veteran-Owned Small Business Concern:

A Service-Disabled Veteran-Owned Small Business Concern - (1) means a small business concern (i) not less than 51% of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51% of the stock of which is owned 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. (2) Service-disabled veterans 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). (FAC 97-20)

  • HUBZone Small Business Concern:

A HUBZone Small Business Concern is a small business concern that appears on the List of Qualified HUBZone Small Business Concern maintained by the SBA.

  • Woman-Owned Small Business Concern:

A Woman-Owned Small Business Concern means a small business concern which is at least 51% owned by one or more women; or, in the case of any publicly owned business, at least 51 % of the stock of which is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

  • Minority Business Concern (Non SBA Certified):

A Minority Business Concern is a “non SBA certified” small disadvantaged business that is a small business that is at least 51 percent unconditionally owned by one or more individuals who are both socially and economically disadvantaged, or a publicly owned business having at least 51 % of its stock unconditionally owned by one or more socially and economically disadvantaged individuals, and has its management and daily business controlled by one or more such individuals.

  • Small Disadvantaged Business Concern (SBA Certified):ISIS NOT

A Small Disadvantaged Business Concern is a small business under the size standard applicable to the acquisition and (i) has received certification as a small disadvantaged business concern consistent with 13CFR part 124 subpart B or (ii) submitted a completed application to the SBA or a private certifier to be certified as a SDB and a decision is pending.

SBA (SDB) Certification / Cert. Date:

National Minority Supplier Development Council (NMSDC Certified) IS IS NOT

Misrepresentation of business size classification can result in the assessment of significant criminal and civil penalties and fines. Reference 15 U. S. C. 645d

Section III.

  • Company Profile

Company Name:

Address:

City: StateZip Code:

Majority Owner’s: (if applicable)

Name:

Phone Number:

E-mail Address:

Year Established Under Current Ownership:

Number of Employees: (at present location) Total Employees Worldwide:

Total Annual sales $(M) Total Annual ATI $(M):

Industry:

Construction Contractor Consultant Distributor

Manufacturer Manufacturer Representative

Service ContractorOther (Specify)

  • Number of Employees Normally Assigned to:

Factory/Warehouse

Technical

Administration

  • Plant Area (Sq. Ft.) Assigned to:

Factory/Warehouse

Technical

Administration

  • Geographic Area that can be effectively served
  • Products or Services:
  • Major Customers: (Current or Past)

Signature: ______

Date: ______

PLEASE CONTINUE TO COMPANY PROFILE on AT-10198B

AT-10198A

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