Classification Checklist B Form (completed by the supplier)

Classification Checklist B Form

This form is to be completed by the Supplier.
This form should be completed by all businesses and individuals seeking to do business for the Woods Hole Oceanographic Institution. Please answer the questions below, then select the "Printable Form" button to get a page which is your Classification Checklist B Form. Print the form, sign it, and send it to Procurement at MS#1.

1. What is the legal name and address of your business?

2. Is the business incorporated? Yes No

If yes, provide the Federal Tax ID#:
If no, provide Social Security Number or Tax ID#:

3. Is your business covered by Workers Compensation and General Liability Insurance? Yes No
Please attach copies of Certificates of Insurance to this form.

4. Will the work be performed on Woods Hole Oceanographic Institution property? Yes No
If no, provide location the work be performed:

5. Are you providing all the tools and equipment necessary to complete the work? Yes No
Comments:

6. What is the length of time you expect this project will last?

7. During your engagement, how many hours, days, weeks do you anticipate performing services?

8. How do you anticipate being paid for this project? By the hour Progress payments Lump sum at completion

9. Is the work to be performed for Woods Hole Oceanographic Institution similar to work you do / have done for clients other than WHOI?

10. Have you ever been an employee or student of the Woods Hole Oceanographic Institution? Yes No
If yes, provide title of your last position:

Suppliers's signature: ______________________________________ Date: _____/_____/_____

MS#1 • Woods Hole, MA 02543 • 508.289.2371 • Fax 508.457.2192 • procurement@whoi.edu

Last updated: April 1, 2013

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