Ams Form 010 PDF Details

Ams Form 010, also known as the United States Alien Registration form, was first introduced in 1940. The form is used to track and monitor the comings and goings of all non-citizens in the United States. The form is also used to identify any potential threats to national security. Ams Form 010 must be completed by all non-citizens aged 14 or older and must be renewed every two years. Failure to comply with this requirement can result in fines and/or imprisonment.

QuestionAnswer
Form NameAms Form 010
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesladwp com ams, brookhaven national amsform, ams form 010, ams form system form get

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PROCUREMENT AND PROPERTY MANAGEMENT DIVISION

BROOKHAVEN NATIONAL LABORATORY

Managed by Brookhaven Science Associates, LLC under contract to the U.S. Department of Energy

ACQUISITION MANAGEMENT SYSTEM FORM

Form No. AMS-Form-010

Revision No. 6

APPROVED BY:

D. Rawlings / 03/09/12

PPM Manager/Date

REPRESENTATIONS AND CERTIFICATIONS - SUPPLIER INFORMATION

Company Name Address line 1

Address line 2

City, State, Zip

Country

Phone Number

Fax Number

Email Address

Contractor Certifying Official

Name:

Date:

For BSA use only

Vendor Code:

Buyer/CS:

Taxpayer Identification Number (TIN)

TIN Number

TIN is not required because the Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States; Offeror is an agency or instrumentality of a foreign government; or Offeror is an agency or instrumentality of the Federal Government.

Check if you require a 1099 for Tax Purposes

Common Parent

Offeror is not owned or controlled by a Common Parent

Name and TIN of Common Parent

Name

TIN

Page 1 of 4

Small Business Program Representations

In order to self-certify below that you are a small business you must identify your North American Industry Classification System (NAICS) Code for the product or service you are providing to Brookhaven Science Associates (BSA)/Brookhaven National Laboratory (BNL). You must also identify the applicable small business size standard for that NAICS Code. To be considered a small business against a Size Standard that is for a number of employees the company (including the common parent if any) must employ fewer than the size standard lists and for a Size Standard based on annual sales the company (including the common parent if any) must have an average sales for the past three (3) years that are less than that value.

To look up the NAICS code for the product or service that you are selling to BSA/BNL, go to: http://www.census.gov/naics/2007/index.html and enter a keyword for that product or service.

To look up the size standard for the NAICS code you picked above, go to:

http://www.sba.gov/sites/default/files/Size_Standards_Table.pdf

NAICS Code

Size Standard

Representations - select one of the options below.

The offeror represents that it is a large business concern (BIG)

The offeror represents that it is a foreign business concern (FRG)

The offeror represents that it is an educational institution (EDU)

The offeror represents that it is a federal government agency (FED)

The offeror represents that it is a local government agency (LOC)

The offeror represents that it is a government owned contractor operated concern (GOC)

The offeror represents that it is a non-profit concern (NON)

The offeror represents that it is a small business* concern (SML)

*Offerors that represents itself as a small business concern shall additionally check any of the boxes below that are applicable

The offeror represents that it is a small disadvantaged business concern as defined in 13 CFR 124 (MNR).

The offeror represents that it is a woman owned small business concern (WOM).

The offeror represents that it is a veteran owned small business concern (VET).

The offeror represents that it is a service disabled veteran owned small business concern (DVT).

The offeror represents that it is a US Small Business Administration certified 8(a) small business concern as defined in 13 CFR 124 and that no material change in ownership and/or control has occurred since it was certified by the U.S. Small Business Administration. Please note that a copy of your most recent 8(a) certification letter must be sent to Jill Clough-Johnston, Small Business Liaison Officer, Email address clough@bnl.gov.

The offeror represents that it is a HUBZone small business concern (HUB) listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration. No material change in ownership and/or control, principal office, or HUBZone employee percentage has occurred since it was certified by the Small Business Administration in accordance with 13 CFR part 126. Please note that a copy of your most recent HUB-Zone certification letter must be sent to Jill Clough-Johnston, Small Business Liaison Officer, Email address clough@bnl.gov.

AMS-Form-010, Rev. 6

Page 2 of 4

Date Approved: 03/09/12

Re: Electronic Fund Transfer [AUTOMATIC DEPOSITS (ACH CREDITS)]

BROOKHAVEN NATIONAL LABORATORY Managed by Brookhaven Science Associates, LLC under contract to the U.S. Department of Energy

Authorization Information

BSA Procurement Representative

Seller/Company Name or DBA

Vendor Number (if applicable)

I hereby authorize Brookhaven National Laboratory/Brookhaven Science Associates to make payments to our company by initiating ACH (Automated Clearing House) credit entries or correcting entries to the account indicated below and the financial institution named below, to credit the same to such account. This authorization will remain in effect until the BNL/BSA, the Procurement Representative receives written notification to terminate same. It is my understanding that credit authorizations may be revoked only by notification by the originator as described in the rules and regulations specified by NACHA (National Automated Clearing House Association).

Financial Information

Financial Institution

Transit/ABA # (Bank 9-digit id)

Checking Account #

Email address to Confirm Transfer of Funds into Account

Print Name

Telephone No

Title

Date

Signed: __________________________________

(Signature)

AMS-Form-010, Rev. 6

Page 3 of 4

Date Approved: 03/09/12

Definitions

Certifying Official

Means the individual at the organization identified in the Company Name Box that certifies the information on this form is accurate and complete. This is not a BSA Employee.

Taxpayer Identification Number (TIN)

Means the number required by the Internal Revenue Service (IRS) to be used by the offeror in reporting income tax and other returns. The TIN may be either a Social Security Number or an Employer Identification Number.

Common Parent

Means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member.

For definitions of Small Business and Small Business subcategories, go to

http://www.bnl.gov/ppm/SDB/DefinitionNAICS.asp

Payment Requirements

Effective immediately, in order to do business with BSA, suppliers will be required to provide banking information to allow for Electronic Funds Transfer (EFT) payments. Please include a notification e-mail address where transaction postings will be sent when each transfer is completed.

AMS-Form-010, Rev. 6

Page 4 of 4

Date Approved: 03/09/12

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ams form 010 completion process detailed (stage 1)

2. Once your current task is complete, take the next step – fill out all of these fields - TIN Number, TIN is not required because the, Check if you require a for Tax, Common Parent, Offeror is not owned or controlled, Name and TIN of Common Parent, Name, TIN, and Page of with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Best ways to prepare ams form 010 step 2

People who use this document generally get some things wrong while filling in Name in this part. Make sure you read again whatever you enter here.

3. The following segment will be focused on NAICS Code, Size Standard, Representations select one of the, The offeror represents that it is, The offeror represents that it is, The offeror represents that it is, The offeror represents that it is, The offeror represents that it is, The offeror represents that it is, The offeror represents that it is, The offeror represents that it is, Offerors that represents itself as, The offeror represents that it is, The offeror represents that it is, and The offeror represents that it is - fill in each one of these blank fields.

Step # 3 in completing ams form 010

4. This next section requires some additional information. Ensure you complete all the necessary fields - The offeror represents that it is, AMSForm Rev , Page of , and Date Approved - to proceed further in your process!

Completing segment 4 of ams form 010

5. To wrap up your document, this final part features a number of extra fields. Entering BSA Procurement Representative, SellerCompany Name or DBA, Vendor Number if applicable, I hereby authorize Brookhaven, and Financial Information is going to finalize everything and you'll surely be done in a blink!

Vendor Number if applicable, BSA Procurement Representative, and Financial Information inside ams form 010

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