amentum> ‘Theinrant posted version of ths guidances the document of record Supplier Certification Form | Request Type Is this a new request, or are you updating information? —_|[zINew Dupsate For Updates, please descrive changes: ‘Section 1. Business Idanfication Ts your Company Incorporated TPN" please specty in the US? [Select location of incomporaton: For US Suppliers, please provide WO — Latest IRS.Gov Version ‘Supplier Business Nae Doing Business As (OBA) "Has your company name changed wre lat 12 ments? LIves LINe {fiyesprovice Previous Name and Dato of ounershp change balou: Previous Name [Date of ownership change URL ‘Number of Employees Fdoral Tax Ideniicaion Number (TIN or SSN Gage Cod ‘DUNS Unique Ent 1Dsoarwaaaee: verano Ts your company fulyregisteredin SAMLGOV? | ClYes Ne Ck pi wei peat an eons a cron ane Sa SPB ‘Supplier Corporate Address Details ‘Adress f ‘Aeros 2 iy sae] [sanz] Coury (Use Fg TSO Codey Contact Name ‘Contact Poston Contaet Prone Number Coniaet Email Address ‘AR Coniact Name ‘AR email (mandatory) "AR Phone Remit/Check Address If Different From Above Address F ‘Address = iy ae] [3igtZ | Courity (Use Zig 150 Code} RemiiCheck Email Fe"SSA TEER Sec: Onto Manet age + ‘hese One nnaamentum > ‘heat posted verson of ths gudance she documento cord. Please fill out Payment Instruction Form SCM-715-8-1-F-3 to provide Electronic Payment Details Section 2.__ Business Type (Check all that apply) Ol Agentiroker Distributor oem arena Repair (cots Ciindependent —|CFacity Supply | rnancai Sorvices [CJutites Enea Consultant (Lease/Rent Leliduhihaatill Ube [correo [Cmeaca:prosucs (Ciuteaca servaes [Cjraoa Senmces __[EJProtesiona [cereal Ir senee [Cltowge [Cheng Drv [Citainorance | C1 Goneuing [Ca Frant (CTaiing (Cissiware cov: Dioovt contotis | oper Chev Entty ‘Connections interest Dot ‘Do you provide Aviation, Space or Marine products or services? Lives _CINo = For Serves er you woking onan Arent, Goverment or other Customer site? yes ONo Main Materials!Service Offenngs (Please explain) ‘Section 3. International Ant-Corruption Compliance Certificate By signing this document, the company or inva cries ha l pertinent indvcuas (feos, rectors, employees, et 1) are faniar wit) the ar-coruption and bribery laws and regulon nthe cours) where the Party may perfor ‘work for Amentum CYlevant ant-corupten laws and epuatons), “The Party understands that the relevant ant-comupton laws and regulators prohibit corny ghing oofring to ‘ve sry money or anything ese of valuo, oor forthe Benet of ary goverment ofl, polial pany, party offal or Candidate, oro any ther person while knowing that alo part of the paymantorthing of ake wil bs ofred or passed on to at naial in order to obtain o eta business o dec business to ary parson in connection with any aepoct ot ‘Amertum, ts subsdares, and alates’, business ‘The Party hereby confims is obkaation and sareement Lo comely wth the ralvant ankcorutn le ant regulations ‘The Paty hereby cons that tras no, and no ane woking on bea othe Paty, inuding is owners, tector, offers and ater employees, agents, subcontrstors, and constants, has roqueste, recived or been offered (or has ‘made, promised or afore) a comugx payment orhas hence vile te relent ani-corupton awe and regulations ‘The Party futher conf that if itor anyone else working on behalf ofthe Party shoud eam of infrmation regarding any such paymant or efe, oF any other votton ofthe relevant art-conuponlawe and regulation, wil inmediatay not Amentus Legal Darienamentum> ‘The intranet posted version ofthis guidance the document af reed. Section 4. Other Business Information Business Size Type (SELECT ONCY ONE then proceed To Business Ownership Secon BBW) mat Busnes Ltapesisiness —— C]Forgr-Ounea tons) C]Non rt nas Ownership (S0Bdt al Wat appli minoriy oF dsadvantaged proveed io Secon beiow) Worse-aned (51%) veered Minor Ove 8) Cy SevceDsaied Veter Owned Smet isavantane S00 Below) 5 stot eck Coenen stn B)HUazone (cred by SBA) Expiration Die: [Alaska Nate Corporation (ANC) ELF CERTIFIED SD8'S must meet the cteain 13 CFR Pa fC) Mona reig Proar | Manrconeanes peat wi Sevres NALS. pay NAS ran ln any oO] ‘operate wily Soveral Tst the pay fst and follow with any adaivonal | NAIGS. Pease indieate whether you qualfy as small business in any of the NAICS listed Spyro Comoe acs 27 Cismat eusinoss SuppyiService St Pepwaton Goria NAICS. AH Djsmateusiness ‘SupplyiService Hazara masa cilectonsenievs aes Seatvz@_ Small Business Suppvisonice _SresiFnah Tesi, ood Nes #41 Dismal ausiness Yuma wan omy bars be abv caen fa Feral feu egintn RJ SEZIOR Wyuna) etanra ‘Neo Un 15 USE 5a ny pron no mers fs tr at ates rer eal UBTine nh nel deere ‘et ws Sak soon sshnagns women auras eral woman owe =mal tena WOSb ha SEXESSSMS Seas he emred carte perenne satane pre aon 89.9 Se 30 he a ar ha ‘Soy ows puof esol rt epesecty free cen) ura Seton's eran aps =n) epee mono st ‘Eaton babes sor ensue, mong suprasn and atarmet n()be mage er Senn ae src na se Ty banana AIS cases, eva veces py your Sonar oar (SAW FARDFARS Real Riseaier es eaane Rovian “Coane Po sam RMS tants fesrcaaticapeaesaiesrtmcarns trove sur commence ota [cern tre ege rine en lscemenrrnaerresegeesa es ee ener st Mo ic cee reece ee cree eens ny a eS Poe wh is ushoweanbchak lb Cores ana Atm ney at 9 0 a at Sng we haan ues Pe ab orate aes ‘Section 5. Certification “Te Company cots thatthe representations and formation stated herein aro current, accurate and complete. The Company agrees to nollyAnenlum Series, ne. (Ament) of any changes to theinfomation proved ons profile. Authoriaed anf” Santee Name iz Title Date OCR EY FRVUND tows 2424 Pionse be sure your igatre handle oF ial n= sampsd agate, SPbarwias a Be rejected Fae Shs Seger Onna Margene Biaine ba in