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ORIGINATOR QUESTIONNAIRE
REQUEST FOR INDEPENDENT CONTRACTOR/CONSULTANT SERVICES
Name of consulting firm and/or person providing the service:
1. YES NO Are Consultant’s skills available within the company at the time the work must be accomplished?
2. YES NO Does Consultant’s work scope involve any of the following? If “yes”, a Consultant Agreement is not the appropriate mechanism for securing
services.
Work performed by public accounting firms, information technology consulting firms or tax advisors in the normal course of the
company’s business.
Work performed by law firms or outside counsel in the normal course of the company’s business.
Agreements with sales representatives/agents.
Engineering or technical services in support of operational requirements (such as modeling services).
Customary service agreements such as agreements with advertsing or employment agencies, medical consultations, and routine office,
plant or equipment maintenance services relating to operational activities (i.e., janitorial services, repair of office machines, etc.).
3. YES NO Is the consulting firm or enterprise comprised of 5 or fewer full time, regular employees. If “no”, a Consultant agreement is not the
appropriate mechanism for securing services unless an exception to policy applies.
4. YES NO Has Consultant been previously used? If “yes”, provide division, cost, & duration of each contract on page 2.
5. YES NO Are Consultant’s qualifications attached? If “no” provide explanation as an attachment.
6. YES NO Is Consultant a retiree, a former company employee or one about to retire or leave either the company or an affiliate of the company?
If “yes”:
State date of retirement/termination and division:
Approval of the corporate vice president, human resources, the corporate compliance officer and the assistant general counsel, human
resources and benefits is required.
Moreover, special requirements may apply. See, e.g., “Guidelines for Leasing the Services of Retirees on a Temporary Basis.”
7. YES NO Is Consultant a current or former Government Official whether USA or another country; i.e., an individual elected or appointed to a national,
state or local position, serving (or having served) at the level of legislator (for legislative branch), judge (for judicial branch), or the highest
executive, cabinet or agency position (for executive branch). If yes, this agreement must be reviewed and approved by the Corporate General
Counsel and Chief Compliance Officer. If “yes” state title and agency:
8. YES NO Is Consultant a current or former federal or state government employee? If “yes” state title and agency:
9. YES NO If “yes” to No. 8 above, is the Consultant being hired to perform work connected to the current or former government employment.
“connected to” means involving an activity which relates in whole or in part to the same or similar matter in which (s)he participated in a
decision-making representation or advocacy role while employed by the government. If yes, this agreement must be reviewed and approved
by the Corporate General Counsel and Chief Compliance Officer.
10. YES NO Does Consultant’s work scope involve political activities? If yes, this agreement must be reviewed and approved by the Corporate General
Counsel and the Chief Compliance Officer.
11. YES NO Does Consultant’s work scope involve accounting, information technology, treasury & finance, domestic and foreign taxes or investor
relations? If yes, this agreement must be reviewed and approved by the Chief Accounting Officer.
12. YES NO Does Consultant’s work scope involve legal, health, safety, environmental & risk management? If yes, this agreement must be reviewed and
approved by the Corporate General Counsel.
13. YES NO Does Consultant’s work scope involve employee relations or human resources? If yes, this agreement must be reviewed and approved by
the Corporate Vice President of Human Resources.
14. YES NO Does Consultant’s work scope involve ethics and compliance? If yes, this agreement must be reviewed and approved by the Corporate
Compliance Officer.
15. YES NO Does the scope of work involve process improvement activities? If yes, this agreement must be reviewed and approved by the Director,
Operational Excellence.
16. YES NO Is Consultant a relative of any employee of B&W or a B&W affiliate? If “yes” provide explanation as an attachment.
17. YES NO Are there other relationships that create an appearance of a conflict of interest? If “yes” provide explanation as an attachment.
18. YES NO Has Consultant received a copy of the B&W Code of Business Conduct? If not, please contact Liza Spruill for a hard copy or see the
Ethics web site for a pdf, and provide a copy to the Consultant.
Continued on next page
ORIGINATOR QUESTIONNAIRE
REQUEST FOR INDEPENDENT CONTRACTOR/CONSULTANT SERVICES
Full name and address of consulting company or Consultant:
If consulting company, name of the person(s) doing the work:
Is Consultant a U.S. citizen?
Will the Consultant be working for the company outside the U.S.?
Scope of work:
Please be specific and avoid the use of acronyms. This paragraph will be incorporated into the Agreement.
Please note whether the consultant’s work will require the company to disclose nonpublic nuclear technical
information.
Please allow at least 3 weeks for full approval. Consultant may not begin work prior to final approval of the Consultant
Agreement.
Estimated start date:
Estimated end date:
Maximum cost of contract (for assistance negotiating costs, please contact Procurement):
Hourly rate ($/hr.):
If other than hourly rate, please specify exact terms (such as flat fee, payment of expenses, etc.):
Work history (if applicable):
DIVISION COST TERM or DURATION
Other comments or details:
ORIGINATOR: DATE:
Signature
Printed Name
