A.

Business Information
1.
2.
3.
C S LLC
5. Type
6.
7.
Other
8.
9.
10.
11. Years in Business
Yes No *
12.
*
13.
14.
15.
URL
4.
(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. )
University
Utility
Business Name
Business Address
Website
Payee Identification (List only one)
Parent Company
Foreign Gov`t Agency
Type of Organizational Structure Corporation
Type of Organization (Please check all that apply)
Construction
Service
Women-Owned Disabled Veteran-Owned
Staffing/Temp Agency
Retailer
United States Government Agency
Large Business Small Business
List the EPRI Requester or Designate for your Service or Goods:
Company Size (Per Small Business Administration standards, Federal Regulation, Title 13, Part 121)
Minority-Owned
Diversification (The business is owned at least 51% by a minority, woman or disabled veteran)
Provide a summary organization chart on a separate attachment or list web link.
Consulting
Manufacturing
Fiscal Year End date if other than calendar year end of 12/31
Describe the nature of products/services provided and country where products/services to be performed.
Are you registered at Central Contractor Registration (CCR)?
Current Year Prior Year
Partnership
NV100 07/10R
EPRI NEW/UPDATED VENDOR INFORMATION
Social Security #:
Non-Profit
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.
Federal Tax ID #:
Last 4 digits only
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.
Sole Proprietor
Number of Employees in Company
Two Years Ago
R&D Firm
Country services/work to be performed:
http://www.ccr.gov
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EPRI NV100 07/10R 1 of 11
Yes No
16. Does your insurance coverage meet EPRI's requirement?
17.
18. Yes No
#6 and #7 at:
19.
20.
21. Do you or your company have a Health & Safety Program?
22. Do you or your company have a Drug Screening Program?
23. Do you or your company perform employee background checks?
24. Do you or your company adhere to a code of ethics?
25. Have you or your company performed work under a U.S. Government funded program?
26. Do you or your company have U.S. Government approved billing rates?
27.
28.
29.
Yes No
30a.
30b.
31. I accept I do not accept
B. Foreign Corrupt Practices Act (You may be able to skip this Section. See following.)
1.
candidate for political office, or a relative of such official: Yes * No
1a.
1b.
1c.
Yes No *
2.
Yes No *
*
$2,000,000 per occurrence Minimum
$1,000,000 per accident Minimum
$1,000,000 per accident Minimum
Automobile Liability
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 business territories change, you are required to immediately notify afantoni@epri.com
A relative of any employee(s), officer(s) or director(s) of your business?
I understand the requirements of the Foreign Corrupt Practices Act and agree to
comply with the anti-bribery requirements.
http://www.justice.gov/criminal/fraud/fcpa/
Before you complete Question 3, please familiarize yourself with the
FCPA by going to the U.S. Department of Justice website at
I agree to immediately notify EPRI of any change that would impact the above answers.
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
Someone who has an ownership interest, direct or indirect, in your business?
comply with 10 CFR Part 601, New Restrictions on Lobbying. [Not applicable to foreign entities.]
U.S. Government department or agency?
If you checked "Yes" to any of the Questions 1 or if you checked "No" to Question 2 or 3, please contact
afantoni@epri.com prior to signing this form.
Report Writing/Software Dev. Lab Analyses Mfg/Field Work
Do you have a registered and certified ISO 9000:2000 Quality Assurance Program?
Statutory Limits Minimum
Check all boxes that identify the type of work or describe the services you will provide to EPRI.
Contractor certifies funds from EPRI will not be used for lobbying activities and will
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.
(See the blue tab at the bottom of this worksheet, titled "EPRI Terms and Conditions".)
An employee, officer or director of your business?
3.
For U.S. entities, has a signed Form W-9 been submitted to EPRI's Vendor Committee?
For non-U.S. Entities, has a signed Form W-8BEN been submitted to EPRI's Vendor Committee?
Have you read and accept all EPRIs terms and conditions?
(See the yellow tab at the bottom of this worksheet, titled "W-9".)
(See the orange tab at the bottom of this worksheet, titled "Foreign Tax Withhold".)
Does your Software Quality Assurance Program meets EPRI standards? Refer to
Federal Contracting Suspension/Debarment: Is your company or any of its principals
debarment, declared ineligible, or voluntarily excluded from covered transactions by any
General Commercial Liability
http://mydocs.epri.com/docs/SDRWeb/processguide/index.html
Workers Compensation [Not applicable to foreign entities]
Employer's Liability
EPRI NV100 07/10R 2 of 11
C. Financial Data
1. Provide a copy of your most current Annual Report or link to the report if posted on the internet.
URL
2. Annual Revenue:
Listed
3. Annual revenue last FY by Contract Type:
Other
D. Accounting and Billing Data Yes No
1. Is the accounting system automated?
If YES, list the name of the software.
2. Yes No
Yes No
3.
Does the project cost report show overruns? If NO, explain below.
4. Explain the source documents utilized in preparing invoices for the performance of the contractual effort.
Yes No
5.
E. Labor
1. Who handles the payroll system?
2. Payroll period: Weekly Bi-weekly Semi-monthly Monthly
3. When are pay raises normally given?
4. What are the basis of raises?
5. How is the billed labor rate calculated? Salary divided by 2080 hours, if not explain below
6. Are attendance records/employee hours worked controlled electronically?
7. Yes No
Yes No
8.
b. Do you use compensatory time in lieu of payment? Please explain below.
Two Years Ago
Time & Materials
Cost Reimbursement
EPRI
Fixed Price
Total
Check here if your
company is listed on the
NYSE, NASDAQ, or
other stock exchange
Does the timekeeping system account for all hours worked (including unpaid overtime and
compensatory time?) If No, explain below.
Fiscal Year Forecast
Prior Year Actuals
U.S. Government
Total
Commercial
Is there a conventional double entry accounting system with a general ledger and supporting
journals? If NO, explain below.
- $
- $
Total
- $
- $
Do you have written procedures for the control and approval of paid overtime?
Are you aware that costs billed EPRI must be incurred and paid prior to billing EPRI?
Other (explain)
- $ - $
- $
or manually?
a. Are you aware that paid overtime requires written authorization by EPRI?
EPRI NV100 07/10R 3 of 11
F. Indirect Rate Data (Please skip this section if you will NOT be performing work on a cost reimbursement basis.)
1.
2.
3. If EPRI is to receive U.S. Government rates, please provide the following:
Cognizant U.S. Government Audit Agency
Name of Auditor
Phone No.
4.
Other:
Current Year
Prior Yr: 20__
2 Yrs: 20__
Government Rate?
5. Yes No
G. Vendor Authorized Representative's Acknowledgement & Signature
Title
Cell
Fax
Title
Cell
Fax
Explain how indirect expenses are identified and separated from expenses charged directly to a project:
Actual Actual
G&A
Provisional
Generation Nuclear Power Power Delivery Utilization
By signing below, you acknowledge that the information provided on this form is correct.
E-Mail
Contact
E-mail
Overhead
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.
Provisional
*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.
Email completed form to your EPRI Requester and / or Designate
Signature
Required*
Date
Print Name
Phone
Phone
E-Mail
Environment
Describe your indirect rate structure and allocation base(s). (Example: overhead and direct labor dollars base;
G&A and total cost input):
Actual Provisional
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.
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?
Have questions? You can contact an R&D Contract representative by clicking on the below links.
R
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EPRI NV100 07/10R 4 of 11
Nuclear Related Work
Please complete the below questionnaire if your work is Nuclear-related.
Yes No
1.
2.
3. Please identify the utility
4.
NV100 7/10R
EPRI NEW/UPDATED VENDOR INFORMATION
Please attach a completed copy of this page if you are NOT submitting the excel version of this form.
Please indicate the date of the last audit
If yes, have you been audited by a U.S. Nuclear utility?
Do you have a Nuclear safety-related (10CFR50 Appendix B and 10CFR21)
Quality Assurance Program?
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.
NV100 6/10R
EPRI Standard Contract Terms & Conditions
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.
CRTC
Boilerplate.final.doc
TM TC Boilerplate
final.doc
Request for Taxpayer Identification Number & Certification (W-9)
A.
B.
1 Email VendorCommittee@EPRI.com
2 Fax 650-855-8554
3 Mail EPRI
Accounts Payable
P.O. Box 10412
3420 Hillview Avenue
Palo Alto, CA 94303-0813
NV100 2/10R
Please submit your completed W-9 form to EPRI Accounts Payable by one of the three ways
listed below;
EPRI New Vendor Information
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)
Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding (W-8BEN)
A.
B.
1 Email VendorCommittee@EPRI.com
2 Fax 650-855-8554
3 Mail EPRI
Accounts Payable
P.O. Box 10412
3420 Hillview Avenue
Palo Alto, CA 94303-0813
NV100 2/10R
Please submit your completed W-8BEN form to EPRI Accounts Payable by one of
the three ways listed below;
EPRI New Vendor Information
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)