Application for Registration as a Gwich’in Business

Application for Registration as a Gwich’in Business
Date

MonthDayYear
Business Plan
Business License
Partner Agreement
Corporate Agreement
Businesses desiring to be designated as a Gwich’in Business must complete this application and
qualify for Gwich’in ownership and capability by meeting the following criteria:
- Business ownership and active involvement.
- Local office
- Gwich’in employees.
New ApplicationUpdated Submission
Date of Application*

MonthDayYear
A. CONTACT INFORMATION
Applicant Name:
Business Operating Name:
(if different from applicant)
A.1 Contact Name of Principal
Name

First NameLast Name
Title / Position held:
A.2 GSA Business Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
A.3 Business Mailing Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
A.4 hone / Fax / Email
Phone 1:

Area CodePhone Number
Phone 2:

Area CodePhone Number
Mobile:

Area CodePhone Number
Toll-Free:

Area CodePhone Number
Fax:

Area CodePhone Number
Email:
example@example.com
A.5 Website
URL:
http://
A.6 Preferred Method of Communication
MailPhoneFaxEmail
B. OWNERSHIP
B1. Structure of Business
Sole ProprietorPartnershiipCorporationCo-op
Incorporation Date (If corporation)

MonthDayYear
Date
B.2 Ownership of Business
Ownership*
The Gwich’in designation number is either the enrollment number for an individual or the GTC assigned
number of the currently designated Gwich’in business.

PLEASE NOTE: The following documentation must be provided:

1. Copy of current Business License

2. If the business is a Partnership, a copy of a Partnership Agreement outlining the percentage of
ownership and distribution of earnings; or

3. If the business is a Corporation, a copy of Incorporation Certificate, Share Registry and any
shareholders agreement outlining participating rights.

If the above information is not submitted with the application, approval for listing will be
suspended until the required information is submitted and evaluated.
C. CAPABILITIES
C.1 Goods and Services

Please list below the Goods or Services category which your business supplies and for which you wish to be listed. For broad categories such as ‘general contracting’, ‘oilfield services’,‘camp supplies’, please describe the goods or service area more specifically.
Categories (Click plus(+) sign below to add more categories)*
C.2 Capability in Specific Goods or Service Area
For each Goods or Service Area (listed above) which your business claims capability, please
provide a detailed outline addressing the following criterion for testing:

Criterion 1 – Related experience
Criterion 2 – Employee’s experience/ education
Criterion 3 – Assets

For example: If you have listed ‘Camps’, you must provide an in-depth and detailed explanation to show your 1)
Business experience; 2) qualifications of employees; and 3) availability of required assets.

Note: If you have listed more than one Goods and/or Service, you will be required to submit
Section C.2 Capability in Specific Product or Service Areas for each of the Goods and Services.
C.2.1 Goods or Services Category:
Criteria 1: Prior Business Experience

Explain what similar or related jobs or contracts your business has performed or is currently performing. For example: Describe related tasks and what your business did about them.
Explanation
Criteria 2: Employees Experience and Education

The business should have (internal/to itself) the specific capabilities normally required to operate a business in the product or service area. Provide evidence to demonstrate your employees’capability to provide the products or services in question. To what extent will products/services be provided by sub-contractors instead of your employees? Please provide details. For example: Resumes of employees will show what functions and experience they have at other businesses prior to joining this company. Show what experience they have in this particular product or service area?
Explanation
Criteria 3: Assets

The business should have the required assets and equipment available to perform the desired service and employees normally required to operate a business in the product or service area.Please provide evidence to demonstrate that the assets are available and in working order for this type of work.For example: What kinds of equipment will be involved in providing the products or services? Are the assets, owned by you or sub-contracted, rented? Are the assets in your possession now? What experience do your employees have in operating these assets? If some or all of the assets will be acquired at the time of a contract, please provide details.
Explanation
D. DECLARATION

The undersigned declares that the above information is correct and that the undersigned isauthorized to submit this application on behalf of the applicant.
Signature

Clear
Date

MonthDayYear
Date
Name

TitleFirst NameLast Name
Should be Empty:

Application for Registration as a Gwich’in Business

A. CONTACT INFORMATION

A.1 Contact Name of Principal

A.2 GSA Business Address

A.3 Business Mailing Address

A.4 hone / Fax / Email

A.5 Website

A.6 Preferred Method of Communication

B. OWNERSHIP

B1. Structure of Business

B.2 Ownership of Business

C. CAPABILITIES

C.1 Goods and Services

C.2 Capability in Specific Goods or Service Area

C.2.1 Goods or Services Category:

Criteria 1: Prior Business Experience

Criteria 2: Employees Experience and Education

Criteria 3: Assets

D. DECLARATION