Indian Preference Certification Renewal

If your business is not yet certified, or has experienced a change in ownership or other significant changes, please complete the Indian Preference Vendor Application.

Any person who knowingly or recklessly omits, falsifies, or otherwise misrepresents any material fact shall be subject to all applicable sanctions, penalties, and any other applicable laws, regulations, or procedures of the Oneida Nation of Wisconsin.

Ownership

* Has/Have the owner(s) of the business changed?

Yes
No

Primary Contact Information

Contact First Name

Contact Last Name

Contact Phone Number

Contact Email Address

Business Information

Business Federal ID #

If you do not have a Business Federal ID, enter the Owner's social security number

Business Name

Oneida Vendor #

If you do not have an Oneida Vendor number, leave blank

Insurance Renewal

Insurance

Insurance Expire Date

Acknowledgement

The undersigned, _______, swears that the foregoing statements are true and correct and include all material information necessary to identify and explain the operation of the entity, _______, as well as ownership status thereof.
Further, the undersigned agrees to provide complete and accurate information regarding actual work performed on any project, the payment thereof, and any proposed changes, of the foregoing arrangements and to permit the examination of records, files of the firm or affiliate of said firm in connection with certification procedures. Any misrepresentation will be grounds for decertification.
The undersigned agrees to the following:
“By completing this application I hereby affirm, under penalty of perjury, that the statements I have made herein are true and correct. I understand that if I am granted certification by the Indian Preference Office, my certification may be revoked at any time if it is discovered that any statements I have made on this application are false. I further understand that I may be subject to other sanctions if I commit fraud or misrepresentation in completing this application.”