Requirements |
The Targeted Vendor Database is intended to increase the utilization of Targeted Businesses, business enterprises owned and operated by women, minority and/or disabled persons (WMDBEs). By completing this form and registering for the Targeted Vendor Database you become more accessible to University buyers by becoming listed in the database and being assigned a requisition number.
To ensure that all vendors are of the highest quality and meet the University’s definition of Targeted Business, it is required that each registered vendor be certified by at least one of the following 6 University-recognized Targeted Business Certification Agencies:
*Each asterisk denotes a required field. Incomplete forms cannot be accepted. Please send questions to khou0012@umn.edu or call 612-625-8460.
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Contact Information |
| *Vendor
Category: |
If
other, please list:
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| *Vendor
Name: |
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| *Contact
Name: |
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| Title: |
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| *E-mail
Address: (If you do not have an
e-mail address, please type "Unavailable" in
the box.) |
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| *Street
Address 1: |
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| Street
Address 2: |
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| *City: |
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| *State: |
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| *ZIP
Code: |
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| *Telephone
Number: |
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| Fax
Number: |
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| Web
Page: |
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| Bonding Capacity: |
$
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| List any major clients, including the University of Minnesota: |
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*Business Description:
(1-2 sentences) |
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Targeted Group Business Certification |
For definitions of each type please click on the link.
One or more types can be selected.
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Woman-owned
Disabled-owned
Minority-owned
If
Minority-owned was selected, please select Ethnicity:
African American
Hispanic American
Asian American
American Indian and Alaskan Natives
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*Certification
Agency:
*
Certification Agency must be selected if you are Woman-
or Minority-owned. |
CERT Program
Minnesota Minority Supplier Development Council (MMSDC)
National Minority Supplier Development Council (NMSDC)
Women’s Business Enterprise National Council (WBENC)*
*WBENC certified businesses must submit an electronic copy of the certificate to: khou0012@umn.edu
State of Minnesota
U.S. Small Business Administration (SBA)
If SBA was selected, please select all that apply:
8(a)
HUBZone - Historically Under-utilized Business Zones
SDB - Small Disadvantaged Business
SB - Small Business (self-certified)
WOSB* - Women Owned Small Business
(self-certified)
VOSB* - Veteran Owned Small Business
(self-certified)
SDVOSB* - Service-disabled Veteran Owned Small Business
(self-certified)
*If you have selected a self-certified category (SB, WOSB, VOSB, or SDVOSB), it is required that you certify now that the above selection is true to the best of your knowledge. Please type your name here:
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North
American Industry Classification System (NAICS) |
For
help in determining your NAICS code, or to convert
from Standard Industrial Classification (SIC) Codes
to NAICS codes, refer to https://eweb1.sba.gov/naics/dsp_naicssearch2.cfm
To
choose a NAICS code, click on NAICS
Choices, (this launches a new window with NAICS
listings to choose from), choose a type of service/product
that will bring you to the NAICS numbers. Copy both
the NAICS number and NAICS name and paste into this
form in the NAICS field(s) below.
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*The
Primary (NAICS) code for the above location is: |
| NAICS: |
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| NAICS: |
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| NAICS: |
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| NAICS: |
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| NAICS: |
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| Vendor
Tax Information |
Please
fill in at least one of the tax options below.
You may fill in both options if you choose.
Social
Security Number - The University acknowledges
that this information is private. The Social Security
Number OR valid Federal Tax ID is necessary for the
University to comply with Federal Tax reporting requirements.
Failure to supply either your valid Federal Tax
ID OR your valid Social Security Number may restrict
your ability to do business at the University.
Tax
Identification Number (TIN) - Under penalties
of perjury, (see Section 6109 of the IRS Code for
further penalties) I, the contractor certify that:
The number shown on this form is my correct taxpayer
identification number (TIN) and, I am not subject
to backup withholding because (a) I am exempt from
backup withholding, or (b) I have not been notified
by the Internal Revenue Service (IRS) and I am subject
to backup withholdings as a result of a failure to
report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup
withholding.
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| Federal
Tax ID: |
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| MN
Tax ID: |
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