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Supplier Information on Company Websites

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					                                           Supplier Profile Questionnaire
Section 1 – Supplier Data Sheet and Business Size Certification
Supplier Name


Federal Tax ID (attached Form W-9                SSN                                     Foreign Company                1099 Required?
hereto)
                                         -OR-
                                                                                              Yes                           Yes
                                                                                              No                            No
Primary Contact                                            Company Email


Web Address


Year Established    Number of Employees      Last Year Sales     Predominant Business Type
                                                                    Manufacturer                           Manufacturer/Distributor
                                                                    Distributor                            Service
NAICS Code*                            CAGE*                    DUNS*
                                                                                                             (*See Section 5 – Helpful
                                                                                                                    Websites)
Commodities/Services


Major Customers


Principal Owners


Ethnicity of Principal(s)                                                                                      Citizenship
   African American/Black              Asian-Pacific American                Native American                       U.S.A.
   Hispanic American                   Subcontinent Asian American           Other                                 Other
Business Classification (select as many categories as applicable to your company)
   Large Business
   Small Business (See page 3 for definitions and Section 5 – Helpful Websites
   Small Business Subcategories (check all that apply)
       Certified Small Disadvantaged Business (Must be listed on SBA Dynamic Business Search (PRO-NET); please supply a
       copy of SBA letter.)
       If certification has expired, have or will you apply for re-certification?
           Yes        No (If “yes”, please provide letter from SBA indicating the status of your application.)
       Small Disadvantaged Business (No SBA certification)
       Woman-Owned Small Business
       HUB-Zone Small Business (Please attach SBA certification letter or application, if not yet approved.)
       Veteran-Owned Small Business
       Service-Disabled Veteran-Owned Small Business
   HBCU/MI (Historically Black College or University/Minority Institution)
   NIB/NISH (National Institute of Blind/National Institute of the Severely Handicapped)
Supplier is:
   Independent            A Division of:
                          An Affiliate of:
                          A Subsidiary of:
The undersigned certifies that the above-named company maintains a business classification as indicated and that such
classification is in accordance with all regulatory requirements relating thereto. Further, it is understood and agreed that
misrepresentation of the business classification is subject to penalties as prescribed in FAR 52.219-1.
Signature of Certifying Official             Printed Name of Official             Printed Title of Official     Date




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                                                                                                                   P490-F01.DOT/CM/10.2006 Rev C
Section 2 – Supplier Correspondence Information
Company Name


Physical Address


City                                                        State                 Country                             Zip+4 or Postal Code


Phone                                                               Fax


Congressional District for above address (See Section 5 for helpful website)



Section 3 – Supplier Contact Information
Salesperson                                              Email                                Phone                     Fax


RFQ Person (optional)                                    Email                                Phone                     Fax



Section 4 – Supplier Remittance Information (payments will be forwarded to this address)
Company Name


PO Box/Address


City                                                        State                 Country                             Zip+4 or Postal Code


Phone                                                               Fax



Section 5 – Helpful Websites
                    Northrop Grumman Supplier                 https://oasis.northgrum.com
                    Information -
                    NAICS Code                                http://www.census.gov/epcd/www/naics.html
                     CAGE Code                                https://www.bpn.gov/bincs/begin_search.asp
                     DUNS Number                              http://www.ccr.gov/pdfs/DUNSGuideGovVendors.pdf
                     Congressional District                   http://www.fedstats.gov/qf/
                     HUB-Zone Program/Locator                 https://eweb1.sba.gov/hubzone/internet/
                     PRO-Net Registration                     http://www.pro-net.sba.gov
                     PRO-Net/CCR Lookup                       http://www.ccr.gov/
                     SBA Home Page                            http://www.sba.gov/
                     Dept. of the Treasury W-9 form           http://www.irs.gov/pub/irs-pdf/fw9.pdf?portlet=3

Section 6 – Internal Use Only - Action Required
      Add new remittance vendor                                              Add new correspondence vendor
      New remittance number                                                  New correspondence number

        Change remittance vendor                                             Change correspondence vendor

        Unblock remittance vendor                                            Unblock correspondence vendor

Requestor                                             Buyer Code                                                      Date


Management Approver                                   Signature                                                       Date


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Definitions
Small Business Concerns - a small business as defined pursuant to Section 3 of the Small Business Act and relevant regulations
promulgated pursuant thereto.
Small Disadvantaged Business (SDB) concern - a small business concern that represents, as part of its offer that:
    (1) It has received certification as a small disadvantaged business concern consistent with 13 CFR part 124, Subpart B;
    (2) No material change in disadvantaged ownership and control has occurred since its certification;
    (3) Where the concern is owned by one or more individuals, the net worth of each individual upon whom the certification is
        based does not exceed $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2);
        and
    (4) It is identified, on the date of its representation, as a certified small disadvantaged business in the database maintained by
        the Small Business Administration (PRO-Net).
Socially disadvantaged individuals are those persons who are a member of one the following named groups:
        Black American (African-American)

        Hispanic American

        Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians)

        Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan,
         China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, U.S. Trust Territory of the Pacific Islands
         (Republic of Palau), Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern
         Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru)

        Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan,
         the Maldives Islands, or Nepal)

        Any other individuals certified as disadvantaged by the Small Business Administration
HUB-Zone Small Business concern (HUB-Zone) - a small business concern that appears on the list of qualified HUB-Zone
Small Business concerns maintained by the SBA. "HUB-Zone" is defined as 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.
Service-Disabled Veteran-Owned Small Business concern (SDVOSB) - a small business concern:
    (1) At least 51 percent owned by one or more service-disabled veterans or, in the case of any publicly owned business, not
        less than 51 percent of the stock is owned by one or more service-disabled veterans; and
    (2) 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 veteran.
    (3) Service-disabled veteran 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).
Veteran-Owned Small Business concern (VOSB) - a small business concern:
    (1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of
        any publicly owned business, not less than 51 percent 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.
Women-Owned Small Business concern (WOSB) - a small business concern:
    (1) That is at least 51 percent 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
    (2) Whose management and daily business operations are controlled by one or more women.
HBCU/MI - Historically Black Colleges, Universities, and Minority Institutions.
Historically Black Colleges, Universities - an institution determined by the Secretary of Education to meet the requirements of
34 CFR 608.2.
For the Department of Defense (DoD), the National Aeronautics and Space Administration (NASA), and the Coast Guard, the term
also includes any nonprofit research institution that was an integral part of such a college or university before November 14, 1986.
Minority institution - an institution of higher education meeting the requirements of Section 1046(3) of the Higher Education Act of
1965 (20 U.S.C. 1135d-5(3)) which, for purposes of this clause, includes a Hispanic-serving institution of higher education as
defined in Section 316(b)(1) of the Act (20 U.S.C. 1059c(b)(1)).
Large Business (LB) - any concern not meeting the criteria for qualifying as a small business concern.


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