Supplier/subcontractor registration form




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Email to: Shaw AREVA MOX Services LLC, Gale H. Cone, Supplier Registration Coordinator at registration@moxproject.com

Mail to: Shaw AREVA MOX Services LLC, SRS, Building 706-F, Gale H. Cone #2026, P.O. Box 7097, Aiken SC 29804-7097

FedEx, UPS, DHL: Shaw AREVA MOX Services LLC, SRS F-Area Bldg. 706-1F, Gale H. Cone Bldg. 706-5F #2026, Aiken, SC 29808


INSTRUCTIONS: (Print or Type):

This form must be completed and submitted when a new supplier/subcontractor is being added to the Vendor database

CHECK ONE:  Initial  Revision



SECTION A: SUPPLIER/SUBCONTRACTOR BUSINESS ADDRESS INFORMATION

Company name:

     


Date

     


Originator/Name & Title/Signature

     

Contact Person, Title and Email address:

     


Business Street Address:

     


City:

     


State:

     


Zip Code + 4

     


County:

     


Country

     


Business Phone:

     


Fax No.:

     


Website address:

     


Year Company Established:

     


Number of Employees:

     



Annual Sales for past 3 years:

Yr     $     Yr     $     Yr     $     



BUSINESS CATEGORY:

 Manufacturing

 Distribution

 Service Provider

 Erector/Installer/Constructor

 Professional Service/Consultant

 Transport Carrier

 Other:___________________________



TYPE OF BUSINESS:

SMALL:

 Small business (SB)

 Women-Owned Small Business (WOSB)

 Small Disadvantaged Business (SDB)

 8(a)

Certified date:_____________________



 Veteran-Owned Small Business(VOSB)

 Service-Disabled Veteran-Owned Small

Business (SDVOSB)

 HUBZone Small Business (HUB)

Certified date: ____________________

 Currently listed on SBA’s CCR for the Socio Economic listed in this section



TYPE OF BUSINESS (Continued):

LARGE:

 Large business



FOREIGN:

 Foreign (to include US locations that are foreign owned or controlled)



NON-PROFIT:

 Educational

 Black college

 Hospital

 Other non-profit institution

 Sheltered workshop, handicapped, federal prison



FEDERAL GOVERNMENT:

 Government Agency


OTHER INFORMATION:

Tax ID No:     



A Form W9 is required to be submitted with this registration form.
Dun & Bradstreet No:     

If you do not have a D&B number please indicate N/A in the blank



OTHER INFORMATION (Continued):
 Accept Visa/MasterCard

 GSA Contract #___________________

 ICPT Contract #___________________

Do you utilize electronic commerce to receive purchase orders and send invoices?

 Yes  No

If yes, how?  EDI  Internet  Both

Is your company now or has it ever been involved in bankruptcy or reorganization proceedings?  Yes  No

If yes, please explain in an attachment.


Is your company affiliated with The Shaw Group or AREVA?  Yes  No

If yes, please provide details of your relationship with the company in an attachment.



SECTION C: QUALITY ASSURANCE INFORMATION


NQA-1 (QL1) Procurements: If your company wishes to register to be eligible to receive NQA-1 procurements you MUST complete the NQA-1 Requirements Section on page 2 of this form. You must also complete the MOX Quality Assurance Manual Questionnaire and submit a copy of your QA Manual and/or procedures for review.
 YES, we are submitting the necessary paperwork to become eligible for NQA-1 Procurements. (Procurements listed as QL1. This level of registration also allows you to be eligible to receive any other procurement listed as Non-NQA-1 as defined below.)
 NO, we are only interested in Non-NQA-1 Procurements. (Procurements listed as QL1(C), QL2, QL3 or QL4. QL1(C) is defined as a commercial item that will be dedicated under our NQA-1 program or may require your company to have certain commercial policies and procedures in place as defined in the Request for Proposal (RFP). Quality Assurance requirements will be specific to the procurements listed as QL2. These requirements will be defined in the Request for Proposal (RFP).)
NQA-1 REQUIREMENTS:

Please answer the following question regarding your quality assurance program:
1. Do you have a quality assurance program that complies with NQA-1 1994, 1995 Addendum?

Yes No If you answer NO, you will NOT be able to pre-qualify for procurements requiring an NQA-1 program.





If YES, please answer the following questions:
2. Does your QA Manual or quality program address special handling and storage requirements for nuclear safety related materials?

Yes No


3. Does your QA Manual address the control of software utilized in the evaluation of nuclear safety related materials or performance characteristics? Yes No
Your QA Program is based on (check all the apply) Submit a copy of your manual for review:

 NQA-1      (Enter year)  ISO      (Enter Section)  Other – Please specify      




SECTION D: CONTRACTOR MAILING ADDRESS INFORMATION (Please complete if mailing address is different than the business address)

Company Name:

     


Mailing Address:

     


City:

     


State:

     


Zip Code + 4

     


Foreign Zip Code:

     


SECTION E: CONTRACTOR REMITTANCE (PAYEE) ADDRESS INFORMATION (Please complete if remittance address is different than the business address)

Company Name:

     


Remit to Address:

     


City:

     


State:

     


Zip Code + 4

     


Foreign Zip Code:

     


SECTION F: PRODUCT CODE INFORMATION (Six digit numbers)

Should you need assistance in determining your codes, please visit www.NAICS.com

NAICS

Code


DESCRIPTION

NAICS

Code


DESCRIPTION

     


     

     

     

     


     

     

     

     


     

     

     

     


     

     

     

     


     

     

     

     


     

     

     

     


     

     

     

     


     

     

     

INFORMATION FOR SUPPLIERS AND DISTRIBUTORS REGARDING NQA-1 ACQUISITIONS:

a. If you are a supplier/distributor, and you only perform administrative and cost (order processing), and the product is shipped directly from a Shaw AREVA MOX Services APPROVED MANUFACTURER, you are not required to have a Shaw AREVA MOX Services approved Quality Program.


b. If you are a supplier/distributor, and you only store the product until it is procured and it is shipped in the manufacture’s packaging, with the manufacturer’s documentation and Shaw AREVA MOX Services HAS APPROVED THE MANUFACTURER, then you must have a Shaw AREVA MOX Services Approved Quality Program that relates to quality procedures, document control, material traceability, proper storage, handling, and shipping of the end product.
c. If you are a supplier/distributor, and you are repackaging the product, and Shaw AREVA MOX Services HAS APPROVED THE MANUFACTURER, then you must have a Shaw AREVA MOX Services Approved Quality Program that relates to quality procedures, document control, material traceability, proper storage, handling, repackaging and shipping of the end product. Shaw AREVA MOX Services requires the inclusion of a Certificate of Compliance, certifying your activities were performed properly.

__________________________________________________________________________________________________________________________________

Supplier Registration Coordinator USE ONLY

___ Commercial (Non-NQA-1) ___ NQA-1


Asset Suites Vendor ID: _____________________________ Completed by:_______________________________________ Date:____________




PROC Form 1120 Rev 0 Page of 09 AUG 11


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