Industry Liaison Program Vendor Profile

*Please Note:* This form is strictly for market research and industry exchange. It helps us better understand market capabilities by geographic area. This form is *NOT* a registration to contract with FEMA, and does *NOT* constitute or imply preference for contract award. Information supplied should *NOT* be proprietary or sensitive in nature.

Vendors interested in contracting directly with FEMA should register in SAM.gov

Business Name

Business Website Address

Business Street Address

City

State

County

ZIP Code

Date of Incorporation/Inception

Format YYYY-MM-DD
This field cannot be a future date.

Point of Contact Name

Point of Contact Title

Point of Contact Email

Point of Contact Phone Number

Registered in SAM?

Yes

Commercial and Government Entity (CAGE) Code

This code is assigned through System for Award Management (SAM). If you have not registered, please go to http://www.sam.gov to register prior to completing this form.

Unique Entity Identifier (UEI)

NAIC Code(s)

Limit 5, separated by comma(s).

Is your company currently doing business with FEMA?

Yes

If yes, please list the name of the FEMA office(s)/person(s):

Is your product(s) or service currently on GSA schedule?

Yes

Please select the FEMA core capability with which your company's capabilities most align.

Please select the Strategic Sourcing Vehicle (if applicable)

FSSI Building Maintenance and Operations (BMO)

FirstSource II (IT Hardware & Software Products)

8 (a) STARS III

CIO-SP3 Small Business

CIO-SP3 Unrestricted

VETS 2

Human Capital and Training Solutions (HCaTS)

Program Management, Administrative, Operations (Clerical), and Technical Services II (PACTS II)

Tactical Communications Equipment and Services II (TacCom II)

Does your company accept government purchase cards?

Yes

Have you been a contractor/subcontractor on a FEMA contract in the last 3 years?

Yes

Reason for contacting FEMA:

Industry Liaison Program Website Inquiry

How to do business w/FEMA

Vendor Presentation Meeting

Vendor Profile Form Submission

General Inquiry

How do you envision that your company's capabilities could support FEMA's Core Capabilities?

How do you envision that your company's capabilities could support FEMA's Core Capabilities

Have you previously met with a program office or FEMA representative in the last twelve (12) months?

Yes

If yes please provide that office(s)/person(s) name:

How did you find out about Industry Liaison?

Website

FEMA Small Business

FEMA Representative Referral

Conference

APEX Accelerator

MBDA

FEMA Webinar

Industry Day

Other

Please provide a brief description of your “Other” selection

FEMA Representative Referral Name

Completed by Name

Name of person completing the form.

Completed by Email

Email address of person completing the form.

PRIVACY ACT STATEMENT

AUTHORITY: 6 U.S.C § 796 "Registry of disaster response contractors"
Purpose: DHS/FEMA collects this information to facilitate communication between FEMA and the participants of FEMA's Industry Liaison Program.

Routine Use(s): This information is used for the principal purpose(s) noted above. The information on this form may be disclosed internally within DHS as generally permitted under 5 U.S.C. § 552a(b)(1) of the Privacy Act of 1974, as amended, and will not be shared outside of DHS.

Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may delay or prevent FEMA's sharing of information related to its Industry Liaison Program.

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Industry Liaison Program Vendor Profile

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