"Nonprofit Recognition Application (For Prompt Payment Benefits)" - California

Nonprofit Recognition Application (For Prompt Payment Benefits) is a legal document that was released by the California Department of General Services - a government authority operating within California.

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  • Released on September 1, 2010;
  • The latest edition currently provided by the California Department of General Services;
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State of California
For State Use Only
NONPROFIT RECOGNITION APPLICATION
for Prompt Payment Benefits)
Reviewed by
(
(Rev 9/10)
Return completed application and required documentation to:
Small Business and DVBE Certification
Approval Date
st
707 Third St., 1
Floor, Room 400 MS 210
West Sacramento, CA 95605
(916) 375-4940 (Receptionist)
OSDS Supplier Number
http://www.dgs.ca.gov/pd/Programs/OSDS.aspx
NP-
Date Stamp
PROGRAM DESCRIPTION AND SUBMISSION REQUIREMENTS
Nonprofit organizations are eligible to participate in the Prompt Payment Program as set forth in California Government Code,
Title1, 927 et seq. The Prompt Payment Act encourages expeditious invoice payment to recognized nonprofit organizations.
Although nonprofit organizations are not eligible for small business and/or disabled veteran business enterprise certification, the
Office of Small Business and DVBE Certification recognizes nonprofit organizations for Prompt Payment Program eligibility.
Once recognized, your organization will receive a recognition letter.
1.
FEDERAL EMPLOYER ID. # (FEIN)
2.
BUSINESS TELEPHONE NUMBER
(
)
3.
DOING BUSINESS AS (DBA) NAME
4.
BUSINESS FAX NUMBER
(
)
MAILING ADDRESSS
6.
E-MAIL ADDRESS
5.
(Number, Street, City, State and Zip +4code, P.O. Box OK)
7.
PHYSICAL ADDRESS OF YOUR PRINCIPAL OFFICE
8.
HOMEPAGE
9.
CONTACT PERSON NAME
10. CONTACT PERSON TITLE
11. CONTACT PERSON PHONE
NUMBER
CONTACT PERSON ADDRESS
12.
(Number, Street, City and Zip +4 code, P.O. Box OK)
Original Signature of Nonprofit Representative
13.
Any person willfully providing false information is subject to serious penalties. The signatory of this document must be the applicant firm’s
owner and/or officer and certify that he/she has read and understands the foregoing statement and that all information provided herein is
accurate and truthful. I declare under the penalty of perjury under the laws of the State of California that the foregoing is true and correct.
SIGNATURE
TITLE
PRINTED NAME
DATE SIGNED
For recognition as a Nonprofit Organization, submit the following
:
A completed “Nonprofit Recognition Application”
The entire signed Form 990 “Return of Organization Exempt from Income Tax” for the most recently completed tax year.
If the nonprofit organization was established less than one year ago and has not yet filed Form 990 submit:
A completed “Nonprofit Recognition Application”
The nonprofit’s Articles of Incorporation as filed with the California Secretary of State’s Office.
Pursuant to the Federal Privacy Act (P.L. 93-579) of 1974 and the Information Practices Act (IPA) of 1977 (Civil code Sections 1798, et. Seq.), notice is hereby
given for the request of personal information by this Application. The requested personal information is Mandatory. The principal purpose of the mandatory
information is to determine eligibility for recognition as a Nonprofit Organization. The failure to provide all or any part of the requested information may delay
processing of this Application. No disclosure of personal information will be made unless permissible under Article 6, Section 1798.24 of the IPA of 1977.
Each individual has the right upon request and proper identification, to inspect all personal information in any record maintained on the individual by an
identifying particular. Direct any inquiries on information maintenance to the appropriate IPA Officer in the Department of General Services.
State of California
For State Use Only
NONPROFIT RECOGNITION APPLICATION
for Prompt Payment Benefits)
Reviewed by
(
(Rev 9/10)
Return completed application and required documentation to:
Small Business and DVBE Certification
Approval Date
st
707 Third St., 1
Floor, Room 400 MS 210
West Sacramento, CA 95605
(916) 375-4940 (Receptionist)
OSDS Supplier Number
http://www.dgs.ca.gov/pd/Programs/OSDS.aspx
NP-
Date Stamp
PROGRAM DESCRIPTION AND SUBMISSION REQUIREMENTS
Nonprofit organizations are eligible to participate in the Prompt Payment Program as set forth in California Government Code,
Title1, 927 et seq. The Prompt Payment Act encourages expeditious invoice payment to recognized nonprofit organizations.
Although nonprofit organizations are not eligible for small business and/or disabled veteran business enterprise certification, the
Office of Small Business and DVBE Certification recognizes nonprofit organizations for Prompt Payment Program eligibility.
Once recognized, your organization will receive a recognition letter.
1.
FEDERAL EMPLOYER ID. # (FEIN)
2.
BUSINESS TELEPHONE NUMBER
(
)
3.
DOING BUSINESS AS (DBA) NAME
4.
BUSINESS FAX NUMBER
(
)
MAILING ADDRESSS
6.
E-MAIL ADDRESS
5.
(Number, Street, City, State and Zip +4code, P.O. Box OK)
7.
PHYSICAL ADDRESS OF YOUR PRINCIPAL OFFICE
8.
HOMEPAGE
9.
CONTACT PERSON NAME
10. CONTACT PERSON TITLE
11. CONTACT PERSON PHONE
NUMBER
CONTACT PERSON ADDRESS
12.
(Number, Street, City and Zip +4 code, P.O. Box OK)
Original Signature of Nonprofit Representative
13.
Any person willfully providing false information is subject to serious penalties. The signatory of this document must be the applicant firm’s
owner and/or officer and certify that he/she has read and understands the foregoing statement and that all information provided herein is
accurate and truthful. I declare under the penalty of perjury under the laws of the State of California that the foregoing is true and correct.
SIGNATURE
TITLE
PRINTED NAME
DATE SIGNED
For recognition as a Nonprofit Organization, submit the following
:
A completed “Nonprofit Recognition Application”
The entire signed Form 990 “Return of Organization Exempt from Income Tax” for the most recently completed tax year.
If the nonprofit organization was established less than one year ago and has not yet filed Form 990 submit:
A completed “Nonprofit Recognition Application”
The nonprofit’s Articles of Incorporation as filed with the California Secretary of State’s Office.
Pursuant to the Federal Privacy Act (P.L. 93-579) of 1974 and the Information Practices Act (IPA) of 1977 (Civil code Sections 1798, et. Seq.), notice is hereby
given for the request of personal information by this Application. The requested personal information is Mandatory. The principal purpose of the mandatory
information is to determine eligibility for recognition as a Nonprofit Organization. The failure to provide all or any part of the requested information may delay
processing of this Application. No disclosure of personal information will be made unless permissible under Article 6, Section 1798.24 of the IPA of 1977.
Each individual has the right upon request and proper identification, to inspect all personal information in any record maintained on the individual by an
identifying particular. Direct any inquiries on information maintenance to the appropriate IPA Officer in the Department of General Services.