邢唷??>? ?????欹?_ ??$bjbjzyzy 7h6b6b  ???\\\\\ppp8?L??p??????????|@l'n'n'n'n'n'n'$??W,`?\Q??QQ?\\????}}}Q:\?\?l'}Ql'}}Vt%@8&?喃}鶕???? X'?0??x?^?8&?\8& QQ}QQQQQ??}QQQ?QQQQ?QQQQQQQQQ?B ": CONTRACTOR REQUIREMENTS FORM In order to comply with statutory requirements and/or regulations, Tennessee Tech requires contractors to provide following information prior to the issuance of the contract. Please complete all information and sign as directed.I. Ownership Information  1. Contractor Legal Entity Name (Name used for tax filing purposes): ________________________________________________  2. Is Contractor a permanent resident or citizen of the US?  FORMCHECKBOX  Yes  FORMCHECKBOX  No (If no, state country of citizenship): (Note: Contractors who are individuals and are not US citizens must complete a Foreign National Data Form prior to execution of contract.) 3. Kind of Ownership (Check all that apply)::  FORMCHECKBOX  Government (GO)  FORMCHECKBOX  Non-Profit (NO)  FORMCHECKBOX  Majority (MJ)  FORMCHECKBOX  Minority*  FORMCHECKBOX  Woman (WO)*  FORMCHECKBOX  Small (SM)*  FORMCHECKBOX  State of TN Agency  FORMCHECKBOX  Service-Disabled Veteran* *See reverse side of form for clarification of these categories.4. Minority / Ethnicity Code (Check one):  FORMCHECKBOX  African American (MA)  FORMCHECKBOX  Native American (MN)  FORMCHECKBOX  Hispanic American (MH)  FORMCHECKBOX  Asian American (MS)  FORMCHECKBOX  Other Minority (MO) Specify: _______________________5. Preference for reporting purposes: (Note: If Contractor qualifies in multiple categories as small, woman-owned and/or minority, Contractor is to specify in which category he/she is to be considered for reporting and classification purposes.) Check one only  FORMCHECKBOX  Small  FORMCHECKBOX  Minority  FORMCHECKBOX  Woman-Owned  FORMCHECKBOX  Service-Disabled Veteran 6. Certification: I certify that all of the information as completed above is accurate and true. (Signature required below.) Signed: ______________________________________________________________ Date: __________________________ Name (Printed): ____________________________________Title: ________________________________________________ II. Sales and Use Tax. As a contractual requirement under Tennessee law, vendors who contract with the state of Tennessee must be registered to collect sales tax if they make sales that are subject to the Tennessee sales and use tax. If you are already registered to collect Tennessee sales and use tax, please provide your registration number: _________________________________ (Note: This number is NOT your federal ID number.) If you are not registered, please go to  HYPERLINK "https://tntap.tn.gov/eservices/_/" Tennessee Taxpayer Access Point (TNTAP) and under the header 揕ook Up Information & Requests? select TN Vendor Contract Registration. This will open a survey designed to evaluate whether you must register for sales and use tax. Based on your responses, you will be directed to either register or will be provided with a letter of exemption from sales tax collection. Please provide a copy of the exemption letter or evidence of registration to Tennessee Tech to satisfy this contractual requirement. *Minority Ownership Clarification: A 搈inority-owned business?means a business that is a continuing, independent, for profit business which performs a commercially useful function and is at least fifty-one percent (51%) owned and controlled by one (1) or more minority individuals who are impeded from normal entry into the economic mainstream because of past practices of discrimination based on race or ethnic background. 揗inority?means a person who is a citizen or lawful permanent resident of the United States and who is: African American (a person having origins in any of the black racial groups of Africa); Hispanic (a person of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish culture or origin, regardless of race); Asian American (a person having origins in any of the original peoples of the Far East, Southeast Asia, the Indian subcontinent, or the Pacific Islands); or Native American (a person having origins in any of the original peoples of North America). **Woman-Owned Business Clarification: A 搘oman-owned business?means a business that is a continuing, independent, for profit business which performs a commercially useful function and is at least fifty-one percent (51%) owned and controlled by one (1) or more women; or, in the case of any publicly owned business, at least fifty-one percent (51%) of the stock of which is owned and controlled by one (1) or more women and whose management and daily business operations are under the control of one (1) or more women. ***Small Business Ownership Clarification: A 搒mall business?means a business that is independently owned and operated for profit, is not dominant in its field of operation and is not an affiliate or subsidiary of a business dominant in its field of operation. The Governor抯 Office of Diversity Business Enterprise establishes small business guidelines on industry size standards. The criteria guidelines are required to be met in order for a business to be considered small. The annual receipts or number of employees indicates the maximum allowed for a small business concern and its affiliates to be considered small. TYPE OF BUSINESSANNUAL GROSS SALESNO. OF EMPLOYEESAgriculture, Forestry, Fishing$500,0009Architectural / Design / Engineering$2,000,00030Construction$2,000,00030Educational$1,000,0009Finance, Insurance & Real Estate$1,000,0009Information Systems / Technology$2,000,00030Manufacturing$2,000,00099Marketing / Communications / Public Relations$2,000,00030Medical / Healthcare$2,000,00030Mining$1,000,00049Retail Trade$750,0009Service Industry$500,0009Transportation, Commerce & Utilities$1,000,0009Wholesale Trade$1,000,00019 ****Service-Disabled Veteran Business Enterprise (SDVBE) Clarification: Tennessee Service-Disabled Veteran owned means any person who served honorably on active duty in the Armed Forces of the United States with at least a twenty percent (20%) disability that is service-connected, meaning that such disability was incurred or aggravated in the line of duty in the active military, naval or air service. 揟ennessee Service disabled Veteran Owned Business?means a service-disabled veteran owned business that is a continuing, independent, for-profit business located in the state of Tennessee that performs a commercially useful function, and that: Is at least fifty-one percent (51%) owned and controlled by one (1) or more service-disabled owned veterans; In the case of a business solely owned by one (1) service-disabled veteran and such person抯 spouse, is at least fifty percent (50%) owned and controlled by the service-disabled veteran; or In the case of any publicly owned business, at least fifty-one percent (51%) of the stock of which is owned and controlled by one (1) or more service-disabled veterans and whose management and daily business operations are under the control of one (1) or more service-disabled veterans.     5^?????       ! 箨抟平医冶揭爾唚hYG6 h?Fh?FCJOJQJ^JaJ#h?Fh?F5丆JOJQJ^JaJh?}5丆JOJQJ^JaJh蟤?5丆JOJQJ^JaJh?F5丆JOJQJ^JaJhH ?hH ?5丆JOJQJ^JhH ?h9kS5丆J jh??hq7&UmHnHuh??h?F6丆JaJh€m?6丆JaJh??h?}6丆JaJh??h9kS6丆JaJh?}h9kS5丆JaJh€m?5丆JaJh?}h?}5丆JaJ   ! ???qh $Ifgd蟤?dkd扱$$If杔敀????? t??2&6??(????4?4? la?p?yt€m?$?$If^?a$gdH ? ?$If^?gd€m? ?$If^?gd?}! 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( 4 @ LX`hp?ATTACHMENT AJMHullNormal Hill, Amy2Microsoft Office Word@@芻L徯@燃犋撛@燃犋撛/?? 胀諟.摋+,D胀諟.摋+,P  hp???? ???? ? ??Tennessee Tech University2?  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