Service Agreement Submission Form Service Agreement Submission Form Account Level Information Company Name (Account Name) * Choose Company BlueEarth Marine Group Cabinet Door Service CVF Capital Partners Marsee Foods Jentay Group, LLC Zuniga Foods Not Listed Company Name (Account Name) - new Primary NIST Contact - First Name (for survey) Primary NIST Contact - Last Name (for survey) Contact Email Contact Phone Number of Employees Annual Revenue (millions) $mil Defense Supply Chain? (NIST required field) yes no Transformational Client? (NIST required field) yes no If Transformational, describe: (NIST required field, description requires 50 characters or more) Contract Level Information OMEP Service Agreement Name: 2-3 digit company, 2 digit month, day, year with dashes between, i.e. CDS-12-02-15 Service Agreement Start Date Service Agreement Term (Number of months) Service Agreement Amount (entered into Salesforce) - (3) Service Agreement Cash and Grant Totals - Fill in amounts to the right to equal the Service Agreement Amount above Client Paid (cash amount) (1) Grant Amount (2) Choose Grant from Dropdown choose grant CMTC - NIST DOD Lane County Prosper Portland SEDCOR/HIOP State Business Retention State OBDD If 2nd Grant Amt (2) Choose 2nd Grant from Dropdown choose grant CMTC - NIST DOD Lane County Prosper Portland SEDCOR/HIOP State Business Retention State OBDD Special Terms: Project Risk Assessment: Invoicing - Total Consulting Service Choose Consultant from the dropdown menu consultant BC DL - Dave Looper JG JH JS JV - John Valachovic KK RP SC SS TR TT WB YM Consultant Email (to receive copy of form entry) Choose 3rd Party from the dropdown menu none 3rd Party 1 3rd Party 2 3rd Party 3 3rd Party 4 Choose type of Utilization Units: Delivery or Shadow/Support/Other from the dropdown menu utilization unit Delivery Shadow/Support/Other If you are human, leave this field blank. Submit Start Over
