REGISTRATION

Supplier Information
Please enter 2 valid PO Numbers associated to the Supplier ID and the Total Amount for each.

Account & Company Contact Information
1.Numbers 0 - 9.     2.Upper case letters A - Z.    3.Lower case letters a - z.    4.The characters: ~, !, @@, #, $, %, ^, &, *, (, ), -, _ , +, =, |, \, {, }, [, ], :, ;, <, >, ?, / and comma.

Type of Commodity Provided

U.S. Suppliers
Do you accept credit cards for payment?
If you are a US supplier - will any services be performed outside of the U.S.?
If yes, complete 3.5.6-5 FCPA Compliance Certificate-Company or 3.5.6-6 FCPA Compliance Certificate-Individual.
All Suppliers: List Countries and Attach Tax Compliance Certificates
Country: Date:
*Please attach a list and include each certificate for all additional countries.
For questions contact: corporatetax@dyn-intl.com
Foreign Suppliers
Will any services be performed within the U.S.?
If yes, please complete the applicable IRS form W-8 located at www.irs.gov. IRS requires DynCorp International to maintain original signature and does not accept facsimile.
For ALL suppliers: Certificates of Insurance (Attach a copy of each certificate as applicable)
Insurance Type Certified? Limit of Liability Expiration Date
Aviation Liability Insurance
Automobile Liability Insurance
Workers Compensation, DBA & Employers Liability
Commercial General Liability
Vessel/Marine Liability
Excess Liability
Cargo Insurance
Environmental Liability Insurance
Professional Liability
For ALL Suppliers
The Company agrees that business conducted with DynCorp International (DI) will be performed based on high ethical and compliant standards throughout the entirety of the Company’s engagement with DI. The Company and its employees, affiliates or other personnel who are engaged to conduct business with DI are informed of and understand DI’s Code of Ethics and Business Conduct located at DI’s website http://www.dyn-intl.com . as such, the company acknowledges and understands its commitment to conduct business honestly, ethically, and in accordance with the applicable laws of the u.s. and other countries in which di operates.
Supplier Types :

You may wish to review the definitions for the above categories in the Federal Acquisition Regulation 19.7 or 52.219-8. If you have difficulty ascertaining your size status, please refer to SBA’s website at www.sba.gov/size or contact your local SBA office.

Note: Under 15 USC.645(d), any person who misrepresents a firm’s status as small or small disadvantaged business concern in order to obtain a subcontract that will be counted as a part of DynCorp International’s socioeconomic subcontracting goals, may (a) be punished by imposition of fine, imprisonment, or both; (b) be subject to administrative remedies, including suspension and debarment; and (c) be ineligible for participation in programs conducted under the authority of the act. [Reference: FAR 52.219-1(C)(2)].
 
Authorized Representative Signature: Date:
Expires one (1) year from this date.
Printed Name: Title:
Insurance Requirements and Definitions
DynCorp (DI) Suppliers are required to maintain the following types/levels of insurance. Provide confirmation for each type of insurance and confirm the expiration date of each applicable policy. A certificate of insurance providing evidence of coverage should be submitted with this form as needed.
1. Aviation Liability Insurance: When subcontract performance involves use of aircraft or aviation related services are present, the Subcontractors, and any Subcontractors, as applicable, shall procure and maintain at all times Aviation Liability Insurance (Including War Risk Coverage and/ or Hangarkeepers Liability Coverage if applicable) against death, bodily injury, and property damage claims. Such insurance shall be designated to protect the personnel including all DI employees, and shall indemnify and defend DI from all claims arising out of acts or omissions of the Seller and/or participants under this Subcontract and all Task Order/Purchase Orders issued under this Subcontract. This insurance shall be procured and maintained with limits of not less than $3,000,000 per person/passenger; $3,000,000 with respect to any one person/passenger injured or killed; $3,000,000 per occurrence for property damage; and, subject to that limit per person/passenger, an aggregate limit of $50,000,000 with respect to any number of persons injured or killed as a result of any one accident.
2. Automobile/Motor Liability Insurance: The Seller, and their Sellers, as applicAable, shall procure and maintain at all times Business Automobile/Motor Liability Insurance. The policy shall provide for bodily injury and property damage liability covering the operation of all motor vehicles used in connection with performing the contract. Policies covering motor vehicles operated in the United States shall provide coverage of at least $1,000,000 combined single limit per occurrence for bodily injury and property damage. The amount of liability coverage on other policies shall be commensurate with any legal requirements of the locality and sufficient to meet normal and customary claims.
3. Workers' Compensation, Defense Base Act, and Employers' Liability: The Seller is required to comply with all applicable Federal and State workers' compensation and occupational disease statutes. If occupational diseases are not compensable under those statutes, such occupational diseases shall be covered under the employer's liability section of the insurance policy. Employer's liability limits shall be not less than $1,000,000 for bodily injury by accident per accident and $1,000,000 bodily injury by disease policy limit. Workers Compensation insurance applies to Workers’ Compensation Law of the states, territories and countries where the work takes place, except in states with exclusive or monopolistic funds that do not permit worker's compensation benefits to be written by private insurance companies. Monopolistic states certificate(s) of insurance coverage is/are required if applicable. An alternate employer endorsement in favor of DynCorp International shall also be maintained and a copy of the endorsement sent to DynCorp International Corporate Risk Management. If Workers Compensation under the Defense Base Act (DBA) is applicable to the contract or location of services performed, DBA insurance shall be secured and made evident in the form of a certificate of insurance with an authorized insurance carrier approved by the US Dept of Labor. Vendor is required to meet the Defense Base Act insurance requirements of all DynCorp International customers that will be supported under this agreement.
4. Commercial General Liability: The Seller, and their Sellers, as applicable, shall provide commercial general liability insurance covering bodily injury, property damage, advertising, and personal injury liability, including contractual liability coverage, written on a comprehensive form of policy with a limit of at least $1,000,000 per occurrence, $2,000,000 general liability aggregate and $2,000,000 products/completed operations aggregate. Coverage may not be limited to the territory or regions provided in the SoW.
5. Vessel/Marine Liability: When subcontract performance involves the use, lease, or charter of vessels, the Seller, and their Sellers, as applicable, shall provide vessel liability insurance in the amount of $5,000,000 per occurrence for Protection and Indemnity insurance, $5,000,000 per occurrence for Pollution Liability insurance, and Hull and Machinery insurance for fair market value of each vessel. If the scope of work includes Terminal and/or ship repairing operations, Marine General Liability Insurance is required with a limit of liability in the amount of $5,000,000 per occurrence.
6. Excess Liability: The Seller, and their Sellers, as applicable, shall provide umbrella and or excess liability covering general liability, automobile liability, and employer’s liability. The insurance provided under this section must be in the amount of not less than $4,000,000 per occurrence and be excess over all underlying insurance coverage listed.
7. Professional Liability Insurance: For projects involving Professional Services (Architects, Engineers, Consultants, Medical Professionals, etc.), the seller shall maintain professional liability coverage during the term of this agreement. The limits of this coverage shall be a minimum of $5,000,000 limit per occurrence and aggregate. This requirement shall extend to all professional subcontractors employed by the prime consultant, engineer , surveyor, or medical services provider. Seller shall provide certification of such insurance and a copy of the policy upon request. If coverage is provided under a “claims made” form, coverage must be maintained for at least three (3) years following the completion of this contract.
8. Cargo Insurance: For contracts that involve marine cargo shipments, including the use of a Freight Forwarding company, Seller must provide Cargo insurance to cover the full value of each individual shipment.
9. Environmental Liability: For programs involving the handling, transporting, or storage of waste and/or hazardous materials, the seller shall maintain Contractors Pollution Liability (CPL) insurance coverage during the term of this agreement. The limits of this coverage shall be a minimum of $5,000,000 per occurrence and aggregate. CPL insurance shall include coverage for transportation and waste disposal. If coverage is provided under a “claims made” for zm, coverage must be maintained for at least three (3) years following the completion of this contract.
Commodity Definitions
Products: Tangible goods.
Subcontracted : Services subcontracted by DynCorp International (Prime Contractor) including construction, dining and facility services, labor.
Financial/Accounting/Legal Services: includes banking, accounting and legal services.


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