SMALL BUSINESS CATEGORIES, DEFINITIONS & INSTRUCTIONS

GOVERNMENT REGULATIONS: We are required by Public Law 95-507 and applicable Federal Government regulations to identify the size and ownership status of our suppliers. If you are unsure about your status, contact the nearest U.S. Small Business Administration Office (SBA) for guidance or see: http://www.sba.gov/certifications

General Instructions: Vendors are encouraged to complete the application with as much detail as possible. This will help to ensure that your application is properly registered in the UAB Procurement system and ready to receive transactions.

When completing the sections listed below please use the following guidelines.

"Female Owned, Male Owned and Multi-Owned
"Disadvantaged, Hubzone, Veteran, or Service Disabled Veteran"

If the company is owned by only one individual, it should be classified as either a Female Owned or Male Owned Firm. The company further be classified in the category that best fits ownership. (Non-Disadvantaged, Hubzone, Veteran Owned, Service Disabled Veteran Owned, Disadvantaged, etc.)

If the company is owned by multiple individuals the classification should be as follows.

Multi-Owned where all parties are of the same sex should be classified as either Female Owned or Male Owned

Multi-Owned where parties are of differing sex should be classified in the category representing 51% controlling ownership.

If ownership is equal the classification should be Multi-Owned only.

If Multi-Owned and all parties are of the same ethnicity company should also be classified in the appropriate disadvantaged category.

If Multi-Owned and parties are of differing ethnicity company should be classified in the disadvantaged category representing 51% controlling ownership.

If Multi-Owned where parties are of differing ethnicity and equal ownership company should also be classified in the "Other" disadvantaged category.

SMALL BUSINESS: A business, including its affiliates, which is independently owned and operated, not dominant in the field of operation in which it is bidding on government contracts and qualified as a small business under the criteria in 13 C.F.R. Part 121 and the size standard applicable to this acquisition. The small business must be located and operate primarily in the U.S. Together with its affiliates, it must meet the numerical size standards based on business type or North American Industry Classification System (NAICS) Code.

DISADVANTAGED BUSINESS: A 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 that has a least 51 percent of its stock unconditionally owned by one or more socially (individuals that have been subjected to racial or ethnic prejudice or cultural bias) and economically (individuals whose ability to compete in the free enterprise system has been impaired due to diminished capital and credit opportunities) disadvantaged individuals and has its management and daily business controlled by one or more such individuals.

(01- Black American, 02-Hispanic American, 03-American Indian, 04-Asian Pacific American, 05-Asian Indian American, 06 Sheltered Workshop)

NOTE: If business is at least 51 percent unconditionally owned by more than one individual, and the joint owners are of differing ethnicity, business should be classified as 07 - Other Socially and Economically Disadvantaged Group.

WOMAN-OWNED BUSINESS: A business which is 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 whose management and daily business operations are controlled by one or more women.

VETERAN-OWNED BUSINESS: A business that is at least 51 percent owned by a veteran who also controls and operates the business. Control in this context means exercising the power to make policy decisions. Operate in this context means actively involved in day-to-day management. For the purpose of this definition, eligible veterans include: (a) a person who served in the U.S. Armed Forces and who was discharged or released under conditions other than dishonorable; (b) Vietnam era veterans who served for a period of more than 180 days, any part of which was between August 5, 1964 and May 7, 1975, and were discharged under conditions other than dishonorable; and (c) disabled veterans with a minimum compensable disability of 30 percent, or a veteran who was discharged for disability.

SERVICE-DISABLED VETERANS: A business where 51 percent of which is owned by one or more service-disabled veterans or, in the case any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and 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 a veteran.

HUBZONE BUSINESS ENTERPRISE: A business that appears on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration. A HUBZone is a historically underutilized business zone, which is an area located within one or more qualified census tracts, qualified non-metropolitan counties, or lands within the external boundaries of an Indian reservation. It is owned and controlled by one or more U.S. Citizens and at least 35% of its employees reside in a HUBZone.

SHELTERED WORKSHOP: A not-for-profit corporation which gives people with disabilities a controlled or sheltered working environment to assist these people with special needs in progressing toward normal living and allow them to develop their work capacities.

Please complete this vendor application form and depress the submit button to send your vendor application to the Department of Supplier Diversity.

Federal procurement regulations require that we update our vendor file.  Therefore, it is essential that you respond to this request immediately.

Warning:
Failure to return this form will result in assumptions that may not accurately represent your company.

Vendor Name:   Order From Address:   City:   State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maryland Massachusetts Maine Michigan Minnesota Mississippi Missouri Montana Nebraska New Hampshire New Mexico Nevada New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming   Zip:   Phone:   Toll Free:   Fax:   Email Address:   Internet Address:   Customer Service Contact:   Sales Representative: For Alabama   Phone:   Federal TAX ID#:   Dunn & Bradstreet#:   Annual Sales Volume:   Year Company Established:   SS# if sole proprietorship:

Remit to name and address: ( if different form "order from" above )

The following information refers to company ownership. Contact your Regional or District U.S Small Business Administration Office if clarification is needed small or large business classification. (As defined by Code of Federal Regulation (CFR) 13 Part 121.)