EPRI NV100 07/10R 1 of 14

NV100 07/10REPRI NEW/UPDATED VENDOR INFORMATION

List the EPRI Requester or Designate for your Service or Goods:

A. Business Information. Business Name

Business Address.

. Website

. Payee Identification (List only one)Federal Tax ID #:Social Security #: Last 4 digits only

C S LLC. Type of Organizational Structure Corporation Type

PartnershipSole Proprietor Non-Profit

. Parent Company

. Type of Organization (Please check all that apply)Service R&D Firm UniversityUnited States Government Agency Consulting UtilityForeign Gov`t Agency Manufacturing RetailerStaffing/Temp Agency Construction Other

. Describe the nature of products/services provided and country where products/services to be performed.

Country services/work to be performed:

. Fiscal Year End date if other than calendar year end of 12/31

Current Year Prior Year Two Years Ago. Number of Employees in Company

. Years in BusinessYes

. Are you registered at Central Contractor Registration (CCR)?*

. Company Size (Per Small Business Administration standards, Federal Regulation, Title 13, Part 121)Small Business Large Business

. Diversification (The business is owned at least 51% by a minority, woman or disabled veteran)Minority-Owned Women-Owned Disabled Veteran-Owned

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.

(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. )

No *http://www.ccr.gov

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.

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. Provide a summary organization chart on a separate attachment or list web link.URL

Yes No. Does your insurance coverage meet EPRI's requirement?

. General Commercial Liability $2,000,000 per occurrence Minimum Automobile Liability $1,000,000 per accident Minimum Employer's Liability $1,000,000 per accident Minimum Workers’ Compensation [Not applicable to foreign entities] Statutory Limits Minimum

. Yes No#6 and #7 at:

.

. Do you have a registered and certified ISO 9000:2000 Quality Assurance Program?

. Do you or your company have a Health & Safety Program?

. Do you or your company have a Drug Screening Program?

. Do you or your company perform employee background checks?

. Do you or your company adhere to a code of ethics?

. Have you or your company performed work under a U.S. Government funded program?

. Do you or your company have U.S. Government approved billing rates?

. Federal Contracting Suspension/Debarment: Is your company or any of its principals debarment, declared ineligible, or voluntarily excluded from covered transactions by any U.S. Government department or agency?

. Contractor certifies funds from EPRI will not be used for lobbying activities and willcomply with 10 CFR Part 601, New Restrictions on Lobbying. [Not applicable to foreign entities.]

. Check all boxes that identify the type of work or describe the services you will provide to EPRI. Report Writing/Software Dev. Lab Analyses Mfg/Field Work

Yes No30a. For U.S. entities, has a signed Form W-9 been submitted to EPRI's Vendor Committee?

(See the yellow tab at the bottom of this worksheet, titled "W-9".)30b. For non-U.S. Entities, has a signed Form W-8BEN been submitted to EPRI's Vendor Committee?

(See the orange tab at the bottom of this worksheet, titled "Foreign Tax Withhold".). Have you read and accept all EPRI’s terms and conditions? I accept I do not accept

(See the blue tab at the bottom of this worksheet, titled "EPRI Terms and Conditions".)

.

candidate for political office, or a relative of such official: No1a. Someone who has an ownership interest, direct or indirect, in your business? 1b. An employee, officer or director of your business? 1c. A relative of any employee(s), officer(s) or director(s) of your business?

Yes . I agree to immediately notify EPRI of any change that would impact the above answers.

Does your Software Quality Assurance Program meets EPRI standards?  Refer tohttp://mydocs.epri.com/docs/SDRWeb/processguide/index.html

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.

B. Foreign Corrupt Practices Act (You may be able to skip this Section. See following.)

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

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

Yes *

No *

Before you complete Question 3, please familiarize yourself with the FCPA by going to the U.S. Department of Justice website at http://www.justice.gov/criminal/fraud/fcpa/

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. Yes

*

C. Financial Data. Provide a copy of your most current Annual Report or link to the report if posted on the internet.

URL

. Annual Revenue: Total EPRIListed Fiscal Year Forecast

Prior Year ActualsTwo Years Ago

. Annual revenue last FY by Contract Type: U.S. Government Commercial TotalCost Reimbursement $ - Time & Materials $ - Fixed Price $ - Other $ - Total $ - $ - $ -

D. Accounting and Billing Data Yes No. Is the accounting system automated?

If YES, list the name of the software.

. Yes No

Yes No. Does the project cost report show overruns? If NO, explain below.

. Explain the source documents utilized in preparing invoices for the performance of the contractual effort.

Yes No. Are you aware that costs billed EPRI must be incurred and paid prior to billing EPRI?

E. Labor. Who handles the payroll system?

. Payroll period: Weekly Bi-weekly Semi-monthly Monthly Other (explain)

. When are pay raises normally given?

. What are the basis of raises?

. How is the billed labor rate calculated? Salary divided by 2080 hours, if not explain below

. Are attendance records/employee hours worked controlled electronically? or manually?

. Yes No

I understand the requirements of the Foreign Corrupt Practices Act and agree to comply with the anti-bribery requirements.

No *

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.

Check here if your company is listed on the NYSE, NASDAQ, or other stock exchange

Is there a conventional double entry accounting system with a general ledger and supporting journals? If NO, explain below.

Does the timekeeping system account for all hours worked (including unpaid overtime and compensatory time?) If No, explain below.

EPRI NV100 07/10R 4 of 14

Yes No. Do you have written procedures for the control and approval of paid overtime?

a. Are you aware that paid overtime requires written authorization by EPRI?b. Do you use compensatory time in lieu of payment? Please explain below.

.

. Explain how indirect expenses are identified and separated from expenses charged directly to a project:

. If EPRI is to receive U.S. Government rates, please provide the following:Cognizant U.S. Government Audit Agency

Name of Auditor

Phone No. E-mail

. 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.

Overhead G&A Other:Provisional Actual Provisional Actual Provisional Actual

Current YearPrior Yr: 20__

2 Yrs: 20__Government Rate?

. Yes No

G. Vendor Authorized Representative's Acknowledgement & Signature By signing below, you acknowledge that the information provided on this form is correct.

Date

Print Name Title

Phone Cell

E-Mail Fax

Contact Title

Phone Cell

E-Mail Fax

F. Indirect Rate Data (Please skip this section if you will NOT be performing work on a cost reimbursement basis.)

Describe your indirect rate structure and allocation base(s). (Example: overhead and direct labor dollars base; G&A and total cost input):

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?

Signature Required*

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.

Have questions? You can contact an R&D Contract representative by clicking on the below links.Environment Generation Nuclear Power Power Delivery Utilization

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Email completed form to your EPRI Requester and / or Designate*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.

NV100 7/10R

EPRI NEW/UPDATED VENDOR INFORMATION

Nuclear Related Work

Please complete the below questionnaire if your work is Nuclear-related.Yes No

.

.

. Please identify the utility

. Please indicate the date of the last audit

Do you have a Nuclear safety-related (10CFR50 Appendix B and 10CFR21) Quality Assurance Program?

If yes, have you been audited by a U.S. Nuclear utility? 

Please attach a completed copy of this page if you are NOT submitting the excel version of this form.

NV100 6/10R

EPRI Standard Contract Terms & Conditions

Cost Reimbursement Terms & Conditions Contract

Time & Material Terms & Conditions Contract

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.

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.

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.

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

NV100 2/10R

EPRI New Vendor Information Request for Taxpayer Identification Number & Certification (W-9)

A.

B.

1 Email

2 Fax

3 Mail

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)

Please submit your completed W-9 form to EPRI Accounts Payable by one of the three ways listed below;

NV100 2/10R

EPRI New Vendor Information Request for Taxpayer Identification Number & Certification (W-9)

650-855-8554

EPRIAccounts PayableP.O. Box 104123420 Hillview AvenuePalo Alto, CA 94303-0813

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)

Please submit your completed W-9 form to EPRI Accounts Payable by one of the three ways listed below;

VendorCommittee@EPRI.com

NV100 2/10R

EPRI New Vendor Information Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding (W-8BEN)

A.

B.

1 Email

2 Fax 650-855-8554

3 Mail EPRIAccounts PayableP.O. Box 104123420 Hillview AvenuePalo Alto, CA 94303-0813

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)

Please submit your completed W-8BEN form to EPRI Accounts Payable by one of the three ways listed below;

VendorCommittee@EPRI.com