VMF_with_NTTC.pdf

Vendor Maintenance Form Vendor # or Employee #

N3B USE ONLY

Order From:

PLEASE CHECK ALL THAT APPLY:

Code Socio Economic Category Code Socio Economic Category L Large SDVOSB Service Disabled Veteran Owned

HUBZNE Hub Zone VOSB Veteran-owned Small Business SB Small Business WOSB Woman-owned Small Business SDB Small Disadvantaged Business WOO Woman-owned Other Than Small

SDVWHZ Small Disadvantaged Service Disabled Veteran Woman Owned HUB Zone

SDWHZ Small Disadvantaged Woman Owned Hub Zone

VOHZ Veteran Owned Hub Zone SDWO Small Disadvantaged Woman Owned

SDVOHZ Service Disabled Veteran Owned Hub Zone

Procurement Department Finance Department

Submitted By:

Date Submitted:

Approved by:

Approved date:

Entered By:

Date Entered:

N3B Form 9061, Rev.0, (04/18)

Name:

Address:

City:

State:

Zip (Including +4):

POC Name: Phone No:

W-9 Attached 1099 Vendor If neither, please explain:

New Modify Payment Name Change:

NET 30 Credit Card Only

Remit To: Legal Name per W-9:

Address:

City:

State:

Zip (Including +4):

E-mail Address:

Vendors are encouraged to register on SAM.gov. The System for Award Management (SAM) is an official website of the U.S. government. There is no cost to use SAM. You can use this site for FREE to register to do business with the U.S. government. If you already have an active registration on SAM.gov that corresponds to the W-9 you are providing, please provide the corresponding DUNS Number here: .

If you haven't yet registered on SAM, please complete and submit the attached N3B Representations and Certifications with this Vendor Maintenance Form.

NNM Northern New Mexico Small Business *

*A Northern New Mexico (NNM) Small Business concern is a small business that is actively engaged in doing business in NNM, has an operative business location in NNM, and uses labor from NNM. NNM includes the counties of Taos, Santa Fe, Rio Arriba, Sandoval, Mora, San Miguel, and Los Alamos, and the eight regional Pueblos of Nambe, Picuris, Pojoaque, San Ildefonso, Ohkay Owingeh (formerly known as San Juan), Santa Clara, Taos, and Tesuque.

If a business claims to be a NNM small business concern, it must demonstrate it to N3Bs’ satisfaction. Submission of a bid/offer shall at the minimum ensure that:

• it has been properly authorized to do business and has been operating in NNM with a staff of three or more full-time equivalent employees (of which at least 51% reside in NNM), and currently has a facility in NNM that can support the business activity contemplated by the Statement of Work / Scope of Work; or

• It is independently owned (i.e., its owner(s) exercise(s) close control over operations and decisions which are not subject to control or the power to control by others), its majority ownership interest is held by residents of NNM, it has been properly authorized to do business in NNM and currently has a facility in NNM that can support the business activity contemplated by the Statement of Work / Scope of Work.

If your business entity is recognized by the state of New Mexico and is claiming an exemption from New Mexico Gross Receipts Tax (NMGRT), please complete and submit the NM Non-Taxable Transaction Certificate (NTTC) Request attached hereto. Please consult your tax attorney regarding any questions. N3B, LLC cannot advise on any tax related matters.

https://sam.gov/SAM/pages/public/index.jsf https://sam.gov/SAM/pages/public/index.jsf

New Mexico Non-Taxable Transaction Certificate (NM NTTC) Request

This form is for vendors of Newport News Nuclear BWXT - Los Alamos LLC (N3B). To request a NM Non-Taxable Transaction Certificate (NTTC), please provide the information requested below.

Company Name (as registered with Tax Authority)

NOTE: If registered with the State of New Mexico Taxation and Revenue, NM CRS # must be provided.

Only provide Federal EIN if not registered.

New Mexico CRS Identification Number (1 I digit #: ##-######-###)

Mailing Address:

NTTC Type(s) Requested [Check all that apply):

OR Federal ID Number / Social Security Number (9 digit #: ##-####### or ###-##-####)

Type 2: Tangibles that will become part of a manufactured product and resold to the government.

Type 5: Services that will be resold to the government.

Type 6: Construction material, service and leases resold to the government.

Type 11: Tangible personal property consumed in the manufacturing process.

Type 15: Tangible personal property purchased by qualified federal contractors.

Vendor Point of Contact

Name Phone Number

N3B Contact Name/Phone Number

Email

Reference Information (i.e., Purchase Order#, Invoice#, Credit Card Purchase, etc.)

An Equal Opportunity Employer I Newport Nuclear News BWXT Los Alamos LLC 600 6th Street, Los Alamos NM 87544