| Vendor
Information Form |
| GENERAL
INFORMATION |
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Required Fields :: |
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* Company Name:
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* Type of Entity:
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If other:
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* Federal ID Number:
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(SSN if Sole Proprietorship) |
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* Owner's Name:
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(First Name Last Name) |
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* Company Contact:
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(First Name Last Name) |
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* Physical Address:
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* City / State /
Zip:
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* Country:
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Mailing Address Same as Physical Address |
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* Mailing Address:
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* City / State /
Zip:
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* Country:
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* Telephone Number:
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(
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Ext.
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* Fax Number:
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(
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* E-mail Address:
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Company Website (URL):
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| COMPANY
DATA |
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| List
and describe products and/or services that your business offers:
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NAICS
Codes:
PHA has created some Custom NAICS codes for certain industries.
Both general and custom codes are selected using the "Select
NAICS Codes" link to the right. See below links for details
on custom codes:
Engineering
- Contractors
Engineering - Consultants
Environmental
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Click
Here to Select NAICS Codes
To remove items from the list above, highlight
the category and hit Remove from List.
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County:
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If other:
(where business is located) |
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Are you a small business as defined by the
Port of Houston Authority:
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Yes
No
If yes, please review the
PHA SBDP's Policy and Objectives.
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Port of Houston Small
Business Definition:
As defined in the SBDP’s Policy and Procedures, a “Small
Business” is “a firm for which the gross revenues or number
of employees averaged over the past three years, including any affiliates
as defined by 13 C.F.R. § 121.103, does not exceed the size
standards as defined pursuant to Section 3 of the Small Business
Act and 13 C.F.R. § 121.201, and for which the net worth of
each owner does not exceed $750,000, excluding principal residence
and the value of the small business.” Pursuant to the SBDP’s
Policy and Procedures, a small business has a “Significant
Local Presence” if it is located “in one or more of
the counties of Harris, Galveston, Fort Bend, Montgomery, Liberty,
Waller, Chambers, or Brazoria, Texas, with one or more of its employees
regularly based therein.
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How to Become a Port Approved SBE:
1. Your company must be a small business as defined above.
2. Your company must be certified by either the City of
Houston, Houston Minority Business Council (HMBC), Metropolitan
Transit Authority (METRO), the Small Business Administration (SBA)
- 8A Program, and the Women’s Business Enterprise Alliance
(WBEA); a copy of this certificate must be submitted to the Port
of Houston Small Business Group.
3. Your company must complete and submit the PHA Small
Business Development Program Application.
Please note: The Port of Houston Authority is not a small
business certifying agency.
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Is your business certified by one of the accepted
certifying agencies below:
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Yes
No |
| If yes,
by whom? |
City of Houston |
SBA |
| HMBC
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WBEA
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Metro
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| Certificate
Instructions: |
If
yes, please fax (713-670-2498) or upload a copy of your certificate
or letter of certification. The uploaded certificate must
be in a .jpg or .gif file format. Please be sure to fill in all
pertinent information requested. |
| Certifying Agency (1) |
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| Certification No. |
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| Expiration Date |
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(MM/YYYY) |
| Upload Certificate |
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| Certifying Agency (2) |
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| Certification No. |
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| Expiration Date |
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(MM/YYYY) |
| Upload Certificate |
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| Certifying Agency (3) |
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| Certification No. |
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| Expiration Date |
/
(MM/YYYY) |
| Upload Certificate |
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All vendors and contractors will adhere to the Port of Houston Authority's
insurance requirements that are specified in the "Procurement
Packages".
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| By choosing to submit this form,
you certify that the information you have provided above is true
and accurate. |
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