Multiple
organizations must report information about TI suppliers
regarding tax, environmental, business activity,
diversity, and
ethics requirements.
Your cooperation with providing this
information is critical for TI to report
correct information to the appropriate
agencies in the United States.
1.Obtain
the Setup ID which is given in your email
invitation from TI.Texas Instruments registers suppliers on its
database with its classification form and does
not accept the 1099 or other tax documents as a
substitute.
This form is used
as a Substitute W-9. If a requester gives you a form
other than Form W-9 to request your TIN,you must use the requestor's form if it is
substantially similar to the Form W-9.
Remit (pay to) Address - address to which payments
are to be sent.
Bank information for
electronic payment requires completion of a separate EFT
Form.
To provide bank
information for EFT payment, complete the
EFT
Form. Follow the
instructions on the form to submit.
Email address to
receive purchase order – requirement for TI eProcurement
strategy for receipt of orders.
Web Address (URL) -
your company website.
Business Size, Type,
Activity, Category
LARGE, SMALL,
AND SMALL DISADVANTAGED BUSINESS DEFINITIONS AND
CERTIFICATIONS
LARGE
BUSINESS CONCERN - A major corporation with more
than 500 employees.
SMALL BUSINESS
CONCERN - By checking the appropriate box on the
front of this form, the Vendor represents and
certifies that it is a small business concern and
all end items to be furnished will be manufactured
or produced by a small business concern in the
United States, its territories or possessions,
Puerto Rico, or the Trust Territoryof the Pacific Islands.
SMALL DISADVANTAGED
BUSINESS CONCERN - By checking the appropriate
box on the front of this form, the Vendor represents
and certifies that it is a small disadvantaged
business concern.The Vendor represents and certifies that the
Small Business Administration (SBA) has or has not
made a determination concerning the Vendor's status
as a small disadvantaged business concern.If the SBA has made such a determination the
date of the determination was ___/___/___, and the
Vendor certifies that it was found by the SBA to be
socially and economically disadvantaged as a result
of that determination and that no circumstances have
changed to vary that determination, or it was not
found by the SBA not to be socially and economically
disadvantaged as a result of the determination, but
circumstances which caused the determination have
changed.
NOTIFICATION -
The Vendor agrees to notify Texas Instruments,
before award, of any change in its status as a small
disadvantaged business concern, occurring between
the submission of this certification and contract
award.
PENALTY - The
Vendor represents and certifies that the above
information is true and understands that whoever for
the purpose of securing a contract or subcontract
under subsection (a) of section 1207 of Pub. L
99-661, misrepresents the status of any concern or
person as a small business concern owned and
controlled by a minority as described herein shall (i)
be punished by imposition of a fine, imprisonment,
or both; (ii) be subject to administrative remedies
including suspension and disbarment; and (iii) be
ineligible
for participation in programs conducted under the
authority of the Small Business Act.
Business Classification – for minority or
women-owned business only. Requires reporting of
certification agency, certificate number, and date
of certificate expiration.
WOMEN-OWNED BUSINESS DEFINITION – by checking the
appropriate boxes on the front of this form, the Vendor
represents that it is a Women Owned Small business concern.
"Women-Owned" as used in this provision, means a small
business that is at least fifty-one percent (51%) owned by a
woman (women), who is a (are) U.S. citizen(s) and who also
operate and control the business.
Ethic group for qualifying
ownership – selections are defined on the form.
Company Division,
Subsidiary, Country of Non-U.S. Supplier
by
checking the appropriate box on the front of this form,
the Vendor certifies that a program to eliminate the use
of ancient forest wood in derived products does not
exist, has been started, or has been completed for all
products supplied to or through the course of supplying
services to Texas Instruments.
Environmental, Safety, &
Health –
by
checking the appropriate box on the front of this
form, Vendor certifies compliance with, and ensures
that its employees, contractors, subcontractors and
agents comply with, and provide all notices and
other communications required under, all applicable
local, state, federal and international laws,
ordinances, rules, governmental or judicial orders,
regulations and guidelines, including but not
limited to the OccupationalSafety and Health Act ("OSHA") and all
environmental and public and employee health and
safety laws (collectively "ESH Laws").Additionally, the Vendor agrees to comply
with the Federal Acquisition Regulations (FAR
52.223-1) regarding the clean air and water control
acts.
Affirmative Action
Representation Certification –
AFFIRMATIVE ACTION
REPRESENTATION/NON-SEGREGATED FACILITIES - by
checking the appropriate box on the front of this
form, the Vendor represents that it has or has not
filed all required compliance reports required by
FAR 52.222-26 and representations indicating
submission of required compliance reports signed by
proposed subcontractors, will be obtained before
subcontract awards.
A. "Segregated
facilities," as used in this provision, means any
waiting rooms, work areas, rest rooms and wash
rooms, restaurants and other eating areas, time
checks, lockerrooms and other storage or dressing areas,
parking lots, drinking fountains, recreation or
entertainment areas, transportation, and housing
facilities provided for employees,that are segregated by explicit directive or
are in fact segregated on the basis of race, color,
religion, or national origin because of habit, local
custom, or otherwise.
B. By the submission
of this form, the Vendor certifies that it does not
and will not maintain or provide for its employees
any segregated facilities at any of its
establishments and that it does not and will not
permit its employees to perform their services at
any location under its control where segregated
facilities are maintained.The Vendor agrees that a breach of this
certification is a violation of the Equal
Opportunity clause in the contract.
C. The Vendor further
agrees that (except where it has obtained identical
certifications from proposed subcontractors for
specific time periods) it will:
Obtain identical
certifications from proposed subcontractors before
the award of subcontracts under which the
subcontractor will be subject to the Equal
Opportunity clause;
Retain the
certifications in the files; and
Forward the following
notice to the proposed subcontractors (except if the
proposed subcontractors have submitted identical
certifications for specific time periods):
[NOTICE TO PROSPECTIVE
SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF
NON - SEGREGATED FACILITIES]
A Certification of Non
- segregated Facilities must be submitted before the
award of a subcontract under which the subcontractor
will be subject to the Equal Opportunity clause.The certification may be submitted either for
each subcontract or for all subcontracts during a
period (i.e. quarterly, semiannual, or annually).NOTE: The penalty for making false statements
is prescribed in 18 U.S.C. 1001.
Quality systems
certifications – certification for quality systems such
as ISO9000.
Ethics questions - does
the supplier employ current or former TI employees as
Owners, Officers, or Employees.
Name, Title, phone number
of the person completing the registration form.
CERTIFICATION& PENALTIES
Under penalties of
perjury, I certify that:
1. The number shown on
this form is my correct taxpayer identification
number (or I am waiting for a number to be issued to
me), and
2. I am not subject to
backup withholding because: (a) I am exempt from
backup withholding., or(b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup
withholding as a result of a failure to report all
interest or dividends, or (c) the IRS has notified
me that I am no longer subject to backup
withholding.
Failure to furnish TINIf you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for
each such failure unless your failure is due to
reasonable cause and not to willful neglect.
Civil penalty for
false information with respect to withholdingIf you make a false statement with no
reasonable basis that results in no backup
withholding, you are subjectto a $500 penalty.
Criminal penalty for
falsifying InformationWillfully falsifying certifications or
affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINsIf the requester discloses or uses TINs in
violation of Federal law, the requester may be
subject to civil and criminal penalties.