NV100 07/10R

EPRI NEW/UPDATED VENDOR INFORMATION

The information requested on this form is designed to help EPRI identify the types of work your company may be qualified to
perform and to flag areas that may require further discussion prior to awarding a contract. The intent of this form is to expedite
the contracting process by identifying potential issues early in the contracting process. You are not restricted to the below
space and pages. Please add pages or expand lines wherever necessary. This information is considered confidential but may
be shared internally at EPRI.
(Answering No to any of the questions will not disqualify a vendor from doing business with EPRI. Incomplete or blank boxes
will result in unnecessary delays and the form may be rejected. Please be as thorough as possible. )

List the EPRI Requester or Designate for your Service or Goods:

A. Business Information
. Business Name
. Business Address
. Website
. Payee Identification (List only one)

Federal Tax ID #:
Social Security #:

Last 4 digits only

C

. Type of Organizational Structure

Corporation
Partnership
Sole Proprietor

LLC

Type
Non-Profit

. Parent Company
. Type of Organization (Please check all that apply)
Service
R&D Firm
United States Government Agency
Consulting
Manufacturing
Foreign Gov`t Agency
Staffing/Temp Agency
Construction

University
Utility
Retailer
Other

. Describe the nature of products/services provided and country where products/services to be performed.
Country services/work to be performed:
. Fiscal Year End date if other than calendar year end of 12/31
Current Year

Prior Year

Two Years Ago

. Number of Employees in Company

. Years in Business

Not applicable to foreign entities

Yes

No *

http://www.ccr.gov
. Are you registered at Central Contractor Registration (CCR)?
* If you answer NO and anticipate receiving a Federally funded contracts (i.e. ARRA), you must register immediately to avoid
undue delays. Obtaining a DUNS and registering are required to receive awards utilizing ARRA funding.

. Company Size (Per Small Business Administration standards, Federal Regulation, Title 13, Part 121)
Small Business
Large Business
. Diversification (The business is owned at least 51% by a minority, woman or disabled veteran)
Minority-Owned
Women-Owned
Disabled Veteran-Owned
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. Provide a summary organization chart on a separate attachment or list web link.

URL
Yes

No

Yes

No

. Does your insurance coverage meet EPRI's requirement?

. General Commercial Liability
$2,000,000 per occurrence Minimum
Automobile Liability
$1,000,000 per accident Minimum
Employer's Liability
$1,000,000 per accident Minimum
Workers Compensation [Not applicable to foreign entitie
Statutory Limits Minimum
. Does your Software Quality Assurance Program meets EPRI standards? Refer to
#6 and #7 at:

http://mydocs.epri.com/docs/SDRWeb/processguide/index.html

. Is the work to be performed Nuclear-related? If so, please check the "Yes" box at
right and refer to the green tab at the bottom of this worksheet.
.
.
.
.
.
.
.

Do you have a registered and certified ISO 9000:2000 Quality Assurance Program?
Do you or your company have a Health & Safety Program?
Do you or your company have a Drug Screening Program?
Do you or your company perform employee background checks?
Do you or your company adhere to a code of ethics?
Have you or your company performed work under a U.S. Government funded program?
Do you or your company have U.S. Government approved billing rates?

. Federal Contracting Suspension/Debarment: Is your company or any of its principals

debarment, declared ineligible, or voluntarily excluded from covered transactions by any
U.S. Government department or agency?
. Contractor certifies funds from EPRI will not be used for lobbying activities and will
comply with 10 CFR Part 601, New Restrictions on Lobbying. [Not applicable to foreign entities.]
. Check all boxes that identify the type of work or describe the services you will provide to EPRI.
Report Writing/Software Dev.
Lab Analyses
Mfg/Field Work
Yes

No

30a. For U.S. entities, has a signed Form W-9 been submitted to EPRI's Vendor Committee?
(See the yellow tab at the bottom of this worksheet, titled "W-9".)

30b. For non-U.S. Entities, has a signed Form W-8BEN been submitted to EPRI's Vendor Committee?
(See the orange tab at the bottom of this worksheet, titled "Foreign Tax Withhold".)

. Have you read and accept all EPRIs terms and conditions?

I accept

I do not accept

(See the blue tab at the bottom of this worksheet, titled "EPRI Terms and Conditions".)

B. Foreign Corrupt Practices Act (You may be able to skip this Section. See following.)

If business is conducted within the territory of the United States by a U.S. company this section does not need to be completed. If busines

. Please indicate whether any of the below persons is a current or former government official (including individuals
holding positions at government-owned or controlled companies), a political party official, a
Yes *
No
candidate for political office, or a relative of such official:
1a. Someone who has an ownership interest, direct or indirect, in your business?
1b. An employee, officer or director of your business?
1c. A relative of any employee(s), officer(s) or director(s) of your business?
Yes
No *
. I agree to immediately notify EPRI of any change that would impact the above answers.
Before you complete Question 3, please familiarize yourself with the
FCPA by going to the U.S. Department of Justice website at
EPRI NV100 07/10R

http://www.justice.gov/criminal/fraud/fcpa/
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Yes

. I understand the requirements of the Foreign Corrupt Practices Act and agree to
comply with the anti-bribery requirements.
*

No *

If you checked "Yes" to any of the Questions 1 or if you checked "No" to Question 2 or 3, please contact afantoni@

C. Financial Data
. Provide a copy of your most current Annual Report or link to the report if posted on the internet.
URL
. Annual Revenue:
Check here if your
company is listed on the
NYSE, NASDAQ, or
other stock exchange

Listed

Total

EPRI

Commercial

Total

Fiscal Year Forecast

Prior Year Actuals
Two Years Ago

. Annual revenue last FY by Contract Type:

Cost Reimbursement
Time & Materials
Fixed Price
Other
Total

U.S. Government

D. Accounting and Billing Data

$
$
$

$
$

Yes

No

Yes

No

Yes

No

. Is the accounting system automated?

If YES, list the name of the software.
. Is there a conventional double entry accounting system with a general ledger and
supporting journals? If NO, explain below.

. Does the project cost report show overruns? If NO, explain below.

. Explain the source documents utilized in preparing invoices for the performance of the contractual effort.
Yes

No

. Are you aware that costs billed EPRI must be incurred and paid prior to billing EPRI?

E. Labor
. Who handles the payroll system?
. Payroll period:

Weekly

Bi-weekly

Semi-monthly

Monthly

Other (explain)

. When are pay raises normally given?

. What are the basis of raises?
. How is the billed labor rate calculated?

Salary divided by 2080 hours, if not explain below

. Are attendance records/employee hours worked controlled electronically?

. Does the timekeeping system account for all hours worked (including unpaid overtime and
compensatory time?) If No, explain below.
EPRI NV100 07/10R

or manually?
Yes

No

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Yes

No

. Do you have written procedures for the control and approval of paid overtime?
a. Are you aware that paid overtime requires written authorization by EPRI?
b. Do you use compensatory time in lieu of payment? Please explain below.

F. Indirect Rate Data

(Please skip this section if you will NOT be performing work on a cost reimbursement basis.)

. Describe your indirect rate structure and allocation base(s). (Example: overhead and direct labor dollars base;
G&A and total cost input):

. Explain how indirect expenses are identified and separated from expenses charged directly to a project:

. If EPRI is to receive U.S. Government rates, please provide the following:

Cognizant U.S. Government Audit Agency
Name of Auditor
Phone No.

E-mail

. List the current provisional rates and the past three years of actual rates that have been incurred.
Provide URL to rates if posted on internet.
Overhead
Provisional
Actual

G&A
Provisional
Actual

Other:

Provisional

Actual

Current Year
Prior Yr: 20__
2 Yrs: 20__
Government Rate?
. Are you aware the actual indirect rates should be submitted to the EPRI Audit Department
within 120 days from the close of your fiscal year or upon final rate determination with the
U.S. Government?

Yes

No

G. Vendor Authorized Representative's Acknowledgement & Signature

Required

By signing below, you acknowledge that the information provided on this form is correct.
Signature
Required*

Date

Print Name

Title

Phone

Cell

E-Mail

Fax

Complete the below if the Contact Person responsible for answering questions pertaining to the information on
this form is different from the above listed person.
Contact

Title

Phone

Cell

E-Mail

Fax

Have questions? You can contact an R&D Contract representative by clicking on the below links.
Environment
Generation
Nuclear Power
Power Delivery Utilization

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Email completed form to your EPRI Requester and / or Designate

*You may submit this form with an attached scanned copy of the last page with the signature, scan copy this
entire form with the signature, use an electronic signature, or fax to 650-855-8854.

EPRI NV100 07/10R

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NV100 7/10R

EPRI NEW/UPDATED VENDOR INFORMATION

Nuclear Related Work
Please complete the below questionnaire if your work is Nuclear-related.
Yes
. Do you have a Nuclear safety-related (10CFR50 Appendix B and 10CFR21)
Quality Assurance Program?
. If yes, have you been audited by a U.S. Nuclear utility?
. Please identify the utility
. Please indicate the date of the last audit
Please attach a completed copy of this page if you are NOT submitting the excel version of this form.

No

NV100 6/10R

EPRI Standard Contract Terms & Conditions

The below two PDF files are the standard terms and conditions for EPRI contracts; cost
reimbursement and time & materials. Please read the appropriate document and mark either "I
accept" or "I don't accept" for question #31.
Cost Reimbursement Terms & Conditions Contract
Description: Cost-reimbursement types of contracts provide for payment of allowable incurred
costs, to the extent prescribed in the contract. These contracts establish an estimate of total cost
for the purpose of obligating funds and establishing a ceiling that the contractor may not exceed
(except at its own risk) without the approval of EPRI's Contracting Negotiator.

Time & Material Terms & Conditions Contract

Description: A time-and-materials contract provides for acquiring supplies or services on the
basis of(1) Direct labor hours at specified fixed hourly rates that include wages, overhead,
general and administrative expenses, and profit; and (2) Materials at cost, including, if
appropriate, material handling costs as part of material costs.

Please note that the above contract boilerplates are periodically updated. Please review your
contract for any changes before signing.
If you are a University, Independent or Foreign Contractor, please contact any of the
Representatives listed at the bottom of the New Vendor Information form for the specific contract
boilerplate.

NV100 2/10R

EPRI New Vendor Information

Request for Taxpayer Identification Number & Certification (W-9)
A. Please double click on below document image to open, fill, and print. You may also use the
following link to the IRS website for the fill-in form.
Request for Taxpayer Identification Number & Certification (W-9)

B. Please submit your completed W-9 form to EPRI Accounts Payable by one of the three ways
listed below;
1 Email
2 Fax
3 Mail

NV100 2/10R

ew Vendor Information

or Taxpayer Identification Number & Certification (W-9)

lease double click on below document image to open, fill, and print. You may also use the
ollowing link to the IRS website for the fill-in form.
Request for Taxpayer Identification Number & Certification (W-9)

lease submit your completed W-9 form to EPRI Accounts Payable by one of the three ways
sted below;
VendorCommittee@EPRI.com

650-855-8554
EPRI
Accounts Payable
P.O. Box 10412
3420 Hillview Avenue
Palo Alto, CA 94303-0813

NV100 2/10R

EPRI New Vendor Information

Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding (W-8BEN)
A. Please double click on below document image to open, fill-in, and print. You may also use the
following link to the IRS website for the fill-in form.
Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding (W-8BEN)

B. Please submit your completed W-8BEN form to EPRI Accounts Payable by one of
the three ways listed below;
1

Email

VendorCommittee@EPRI.com

Fax

650-855-8554

Mail

EPRI
Accounts Payable
P.O. Box 10412
3420 Hillview Avenue
Palo Alto, CA 94303-0813