PacifiCorp
Vendor Registration Form
Return Completed Registration Form To:
Please Note:
PacifiCorp Procurement
Attention: Vendor Administration Coordinator
825 NE Multnomah Street, Suite 1800
Portland, Oregon 97232
1.
2.
3.
4.
Email: newsupplier@pacificorp.com
Registration forms without a signature will not be
processed
Incomplete registration forms will not be processed
Provide signed copy of W-8 or W-9 Form
A company work history is required
Please complete this form in detail using additional sheets as necessary. Catalogs/Brochures may be submitted as supplemental
information.
Legal Business
Name:
(MUST MATCH FEDERAL
TAX IDENTIFICATION
NUMBER)
Contact Name/Title:
Contact E-Mail
Address:
Business Address:
STREET ADDRESS
CITY
STATE
COUNTRY
ZIP CODE
ADDRESS
CITY
STATE
COUNTRY
ZIP CODE
(ADDRESS/LOCK BOX #)
ADDRESS
CITY
STATE
COUNTRY
ZIP CODE
Phone/FAX Numbers:
(
Mailing Address:
(IF DIFFERENT THAN ABOVE)
Remit to Address:
)
AREA CODE
(
PHONE NUMBER
)
AREA CODE
FAX NUMBER
Internet URL:
Federal Tax Identification Number:
Please provide a signed copy of your W-8 or W-9, whichever form is applicable (Request for Taxpayer Identification Number
and Certification form)
Are there any current or previous employees of PacifiCorp that are employees, officers, or principle stockholders in your
company?
Yes
No
If yes, please list their
names and positions
within your company:
Are you an affiliate of Berkshire Hathaway or Berkshire Hathaway Energy Company?
Yes
No
If yes, please explain:
Are you a member of ISNetworld? (If a contract is awarded, your company may need to join ISNetworld, but it is not required as
part of the registration process. You will be notified at a later point).
Yes
No
Revision 09-17-2015
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SECTION 2:
Company Structure and Financial Structure
Sole Proprietor
Joint Venture
Partnership
Subsidiary
Year Established:
Corporation
Non-Profit
Affiliate
Division of
LLC
Number of Employees:
Dunn & Bradstreet Number:
Dunn & Bradstreet Rating:
State of Incorporation:
Stock Symbol:
Parent Company Name and Incorporated Address:
FINANCIAL DATA
Please indicate your gross annual sales for the last three years. The most recent year is mandatory.
$
$
$
Year
Year
Year
BUSINESS CLASSIFICATION
Are you a certified diversity enterprise? YES
NO
*If Yes, please indicate which diversity classifications apply:
Gender
Race/Ethnicity (If more than one applies, please
mark multiple entries)
Service Disabled
Veteran
LGBT
Female
American Indian/Alaskan Native
Yes
Yes
Male
Asian
No
No
Other, please specify below
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
*If Yes, which agency or organization issued you the certification?
Please attach your certification.
BUSINESS INFORMATION
Have you performed work for, or supplied material to PacifiCorp, its parent company Berkshire Hathaway Energy Company or its
affiliates?
YES
NO
If yes, provide list on an attached sheet and provide your PacifiCorp or Berkshire Hathaway Energy Company or affiliate vendor ID
number(s):
FOREIGN VENDORS
Are you a foreign vendor providing services in the United States? YES
NO
*If yes, please provide your U.S. Tax ID number and a copy of your W-8 form.
Revision 09-17-2015
-2-
SECTION 3:
Indicate geographical areas of business coverage, listing the primary branch location that will support
the following states:
Oregon
Branch Location(s):
Washington
Branch Location(s):
California
Branch Location(s):
Idaho
Branch Location(s):
Utah
Branch Location(s):
Wyoming
Branch Location(s):
Work History

List the projects completed under the company’s present legal name within the last two (2) years for each of the types
of work and/or services selected. Attach a separate listing for each type of service (boiler overhauls, balance of plant
work, turbine valves, etc. (If required, attach additional information using the format shown below
Type of Work
Performed
Client Address
Contact Phone
Location
of Job
Safety
Does your company have a formal safety program?
Revision 09-17-2015
YES
-3-
NO
Contract
Value
Start/Complete
Date(s)
SECTION 4:
Please check all categories that you provide:
Goods & Materials
Batteries
Fire Protection Equipment & Supplies
Office Equipment/Supplies/Furniture
Bearings
Gear Boxes
Oil Water Separators
Belts
Generators
Pipe Products Distributor
Bird Deterrent supplies
Hardware, Miscellaneous
Pipe, Valves & Fittings, Plastic/Steel
Building Supplies
Hardware, Pole Line
Plumbing Heaters & Supplies
Cable & Conductor
Hose & Hose Fittings
Poles, Concrete/Fiberglass/Steel/Wood
Capacitors
HVAC Equipment and Supplies
Pumps
Chemicals, Water Treatment
Ice Machines
Rectifiers
Circuit Breakers
Industrial Supplies
Relay Boards
Compressors
Instruments
Roofing/Siding/Gutter Supplies
Condensers
Insulators
Safety, Protective Equipment/Clothing
Construction Products
Janitorial Supplies
Scaffolding
Control Cabinets
Lifting & Rigging Equipment
Signage
Control instrumentation
Lighting/Fixtures & Supplies
Steel Structures
Cross Arms, Steel/Wood
Locks
Switches/Switchgear
Distribution Structures
Maintenance, Repair and Operations Supplies
Transformers, Power & Distribution
Doors
Manholes
Turbines, Gas/Hydro/Steam/Wind
Electrical Supplies
Material Handling Equipment & Supplies
Uninterruptable Power Supply
Fencing Materials
Metal Buildings
Welding Gases & Supplies
Filters, Air, Water & Oil
Meters
Windows
Fire Protection Equipment & Supplies
Motors
Other __________________________
Applications
Hardware & Infrastructure
Telecom
Consulting
Office Equipment
Other ___________________________
Forklifts
Third Party Logistics Services
Vehicle, Parts
Freight& Trucking Services
Tires
Vehicle, Rentals
Fuel
Vehicle, Filters
Vehicles, Light/Medium Duty/Utility
Oil & Lubricants
Vehicle Repairs
Other __________________________
Asphalt/Paving/Gravel Services
Insulation Services
Security Services
Caterings/Food Services
Janitorial Services
Surveying & Mapping
Circuit Breaker Maintenance
Machine Shop Services
Tank Cleaning and Repair Services
Crane Services
Pest Control Services
Traffic Control Services
Equipment Rental Services
Plumbing Services
Vegetation Management Services
Fabrication Services
Pressure Washing Services
Water Craft Repairs
Fencing Installation & Repair
Protective Coating Services
Water Treatment Services
Hazmat Remediation
Pump Repair Services
Weed Abatement Services
Hydro blasting Services
Road Maintenance Services
Welding Services
Information Technology
Transportation
General Services
Inspection Services
Other _________________________
Professional Services
Advertising Services
Environmental Consultant Services
Other Professional Services
Architectural Services
Financial Services
Photographic Services
Audio Visual Services
Geotechnical Consulting Services
Project Management Services
Civil
Legal Services
Real Estate Services
Electrical
Lobbyist Services
Safety Consultant Services
Engineering Design & Drafting
Mechanical
Staff Augmentation Services
Revision 09-17-2015
-4-
Facility Services
Building & Facility Services
HVAC Services
Paving Services
Building Repair Services
Interior Remodeling Services
Plumbing Services
Electrician Services
Janitorial Services
Roofing Services
Elevator Services
Landscaping Services
Snow Removal Services
Fencing Installation & Repair
Overhead Door Services
Other ______________________
Floor Covering Services
Painting Services
Power Generation - Specialty Goods and Services
Ash Handling Systems & Supplies
Conveyor Belts & Suppliers
Mining, Explosives & deslagging
Ash Ponds
Cooling Towers & Supplies
Heavy Equipment
Backflow Preventer Services
Emission Control Systems & Supplies
Oil Water Separator Services
Boiler Chemicals
Gate Services
Power Plant Overhaul Services
Boiler Tubing
Generator Services
Precipitator and/or scrubbers
Coal Handling Equipment & Supplies
Marine Diving Services
Retention Ponds/Drainage
Condensate Systems & Supplies
Marine Dredging Services
Wind Operations &Maintenance Services
Construction Services, Balance of Plant
Marine, Booms and Deployment
Other ________________________
Transmission & Distribution Specialty Services
Helicopter Services
Pole Test and Treat Services
Substation Construction Services
Line Repair Services
Right of Way Services
Vegetation Management Services
Locating Services
Street Light Maintenance Services
Other ________________________
Please summarize below how your organization can provide value to PacifiCorp.
I ACKNOWLEDGE AND REPRESENT THAT THE INFORMATION FURNISHED IS COMPLETE AND FACTUAL
SIGNATURE
Printed name
mm/dd/yy
DATE
TITLE
Printed Title
NOTE: The box above must be filled out and signed (or electronically signed) and dated or
the vendor registration form will be deemed invalid.
Revision 09-17-2015
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