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Supplier ID
Please enter 2 valid PO Numbers associated to the Supplier ID and the Total Amount for each.
PO Number
Total Amount ($)
Account & Company Contact Information
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First Name
Company Executive Emails
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Company Additional Emails
Address1
Address2
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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
Products
Direct Labor Services
Financial Services
Subcontracted Services
Other:
U.S. Suppliers
Do you accept credit cards for payment?
Yes
No
If you are a US supplier - will any services be performed outside of the U.S.?
Yes
No
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:
Select a Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua & Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahama
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The DRC
Cook Islands
Costa Rica
Côte D'ivoire (Ivory Coast)
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
France, Metropolitan
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard & McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Islamic Republic of Iran
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova, Republic of
Monaco
Mongolia
Monserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Lucia
Samoa
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
St. Helena
St. Kitts and Nevis
St. Pierre & Miquelon
St. Vincent & the Grenadines
Sudan
Suriname
Svalbard & Jan Mayen Islands
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad & Tobago
Tunisia
Turkey
Turkmenistan
Turks & Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom (Great Britain)
United States Minor Outlying Islands
United States of America
United States Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City State (Holy See)
Venezuela
Viet Nam
Wallis & Futuna Islands
Western Sahara
Yemen
Yugoslavia
Zambia
Zimbabwe
Date:
Add Country
*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.?
Yes
No
If yes, please complete the applicable IRS form W-8 located at www.irs.gov. IRS requires Amentum 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
N/A
Yes
No
Automobile Liability Insurance
N/A
Yes
No
Workers Compensation, DBA & Employers Liability
N/A
Yes
No
Commercial General Liability
N/A
Yes
No
Vessel/Marine Liability
N/A
Yes
No
Excess Liability
N/A
Yes
No
Cargo Insurance
N/A
Yes
No
Environmental Liability Insurance
N/A
Yes
No
Professional Liability
N/A
Yes
No
For ALL Suppliers
The Company agrees that business conducted with Amentum 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
https://www.amentum.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 :
Add Type
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 Amentum'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:
2024-10-08
Expires one (1) year from this date.
Printed Name:
Title:
Insurance Requirements and Definitions
Amentum 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 Amentum shall also be maintained and a copy of the endorsement sent to Amentum 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 Amentum 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 Amentum(Prime Contractor) including construction, dining and facility services, labor.
Financial/Accounting/Legal Services: includes banking, accounting and legal services.
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