SRI Supplier Quality System Survey - Rev B - 12-7-15

SRI Supplier Quality System Survey - Rev B - 12-7-15 -...

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SUPPLIER QUALITY SYSTEM SURVEY Instructions: Please complete this form within 5 business days and return via email to [email protected] Email completed form or questions to: [email protected] To enable macros and use the checkboxes below and in the succeeding pages: When you open the document, you will see “Security Warning - Some active content has been disabled” under the Ribbon. Click on Options. Select Enable Content. Click on OK . Contact Information & Company Profile: Date of Survey Completion: Supplier Name: Full Address: Supplier Website: QA Manager and/or ISO Representative: Contact Phone: Contact Email: Home Office Location: Other Facilities: Primary Product/Service Provided: CEPADS-F-05 Rev B December 7, 2015, 2015 Page 1 of 8
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                          SRI VENDOR SELF-CERTIFICATION SIZE STANDARD FORM SRI is required to report statistics to the Federal Government regarding Small Business Utilization. In order to comply with this requirement, it is mandatory that your company provides the information below. COMPANY NAME DATE FOUNDED ADDRESS CITY COUNTY STATE ZIP PAY TO ADDRESS CITY COUNTY STATE ZIP PHONE FAX TAX I.D. NUMBER DUNS NUMBER CAGE / FSCM CODE DEFINITIONS A. S m a ll B u si n e ss: ia a business, including its afiliates, that is independently owned and operated, and qualified as a small business under the criteria and size standards in 13 CFR part 121 (see FAR 19.102). B. HUBZ on e S m a ll B u si n e s s: is a small business that appears on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration (13 CFR 126.103). C. S m a ll Di sa d va n t a g e d B u si n e ss: a small business and either has received certification as a small disadvantaged business concern consistent with 13 CFR part 124, subpart B; and where the concern is owned by one or more disadvantaged individuals, the net worth of each individual upon whom the certification is based does not exceed $750,000 after takin g into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and it is identified, on the date of its representation, as a certified small disadvantaged business concern in the CCR Dynamic Small Business Search database maintained by the Small Business Administration (SBA); or it represents in writing that it qualifies as a small disadvantaged business (SDB) for any Federal subcontracting program if it believes in good faith that it is owned and controlled by one or more socially and economically disadvantaged individuals and meets the SDB eligibility criteria of 13 CFR 124.1002.
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