Vendor Information Questionnaire

Freddie Mac strives to seek out vendors offering the highest quality products and services at the lowest costs. To be considered, please supply us with the information requested below.

= Indicates a Required Field.

Contact Information

Company Name:
Contact Name:

Address Line 1
Line 2
Line 3
Mailstop:

City:
State/Province: (required for U.S. or Canada)
Zip/Postal Code:
Country:

Telephone:
Fax:
Email Address:

State of Incorporation (if other than above):
Company Name where Incorporated (if other than above):



Product/Service Information

Please select the category that best describes your product or service:
Specific Product or Service to be Provided:

Sales/Service Area:



Business Profile

Type of Business 1099 Reportable? If Incorporated, click no
Year Started (YYYY)
Number of Employees Prior Fiscal Year Annual Gross Sales

Stock Symbol (if applic.) Website URL
Exchange Tax ID (SSN)
or
- -
Dun & Bradstreet Number Tax ID (EIN) -

If selected for an engagement, vendor will be required to submit a current W-9 at:
Procurement@freddiemac.com
Freddie Mac
Procurement - MS#A3C
8250 Jones Branch Drive
McLean, VA 22102-3110

Business Licenses/Permits/Registrations
State of Registration Registration/Filing #
NumberCity/County, State of Issuance
License (Type):
Permit (Type):

Diverse Suppliers Status

If vendor is a minority-, women-, disabled-, GLBT- or veteran-owned business please check all boxes below that apply (this information is provided on a voluntary basis). To review Freddie Mac’s definition for businesses under these categories please visit www.freddiemac.com; “Doing Business with Freddie Mac” and click the link “Who Qualifies as a Diverse Supplier”
Disabled-owned GLBT-owned Service Disabled Veteran Veteran
Woman-owned

Minority Owned Business
More than 50% of the ownership or control of which is held by one or more minority individuals; and
More than 50% of the net profit or loss of which accrues to one or more minority individuals
Asian American Black (or African) American Hispanic (or Latino) American Native American or (American Indian)

This company has been certified as a minority/woman owned business enterprise by:
Local Agency Minority Council/Org Other State Agency US Govt Agency

If Other, please explain:

Please e-mail a copy of certification to Supplier_Diversity@Freddiemac.com. If unable to send electronically mail to:
Freddie Mac
Supplier Diversity, MS A3M
8250 Jones Branch Drive
McLean, VA 22102-3110



References

Please provide below three current or past clients that are representative of the work for which you wish to be considered.

Reference #1
Company
Contact Name
Address
City
State/Province (required for U.S. or Canada)
Zip/Postal Code
Country
Telephone
E-mail Address

Please provide a brief description of the products offered and/or professional consulting services provided:
Number of Professional Personnel Assigned (if applicable):
Skill Sets (if applicable):

Reference #2
Company
Contact Name
Address
City
State/Province (required for U.S. or Canada)
Zip/Postal Code
Country
Telephone
E-mail Address

Please provide a brief description of the products offered and/or professional consulting services provided:
Number of Professional Personnel Assigned (if applicable):
Skill Sets (if applicable):

Reference #3
Company
Contact Name
Address
City
State/Province (required for U.S. or Canada)
Zip/Postal Code
Country
Telephone
E-mail Address

Please provide a brief description of the products offered and/or professional consulting services provided:
Number of Professional Personnel Assigned (if applicable):
Skill Sets (if applicable):



Insurance

Provide coverage amounts. If not applicable, please enter a zero, '0', for the amount.

Comprehensive/General Liability Umbrella Liability
Professional Liability Auto Liability
Fidelity Bond Other
Errors & Omissions



General

Please check the applicable boxes. Use the space below to provide explanations for any 'yes' answers.

1)Has Freddie Mac ever previously done business with your Company?
2)Does any member of your Company have a personal relationship with a current Freddie Mac employee?
3)Have you or any key employees ever been employed by Freddie Mac?
4)In the past two years has your company provided any services to the Office of Federal Housing Enterprise Oversight, Department of Housing and Urban Development or Federal National Mortgage (Fannie Mae)?
5)Are you currently or previously been a defendant in a lawsuit brought by a client or supplier?
6)Have you ever filed for protection from creditors under a Federal or State bankruptcy statute?
1 owners, partners, officers, anyone holding 10% or more of company stock if publicly traded and key employees.
2 an employee likely to perform a managerial role in delivering your potential product or who has played a role in establishing contact between companies



Quality Commitment

List below any trade, business or consumer organizations your company is a member of:



List below any accolades/awards received by your company or senior officers




Referral

How did you learn of this questionnaire? If you are providing an unsolicited offer for our review, please skip and continue to the next section.



Signature

Signature below represents that all supplied information is complete and accurate.

As the authorized representative of the contractor identified above, I agree that by typing my name in the "Signature" box below and by typing my title in the "Title" box below and transmitting or submitting this information to Freddie Mac, I have signed and intended to sign this Vendor Information Questionnaire on behalf of said contractor using an electronic signature. On behalf of said contractor, I further agree that said contractor will be bound by the statements in and terms of this electronic record in the same manner that said contractor would have been bound if I had signed a paper Vendor Information Questionnaire using an ink pen and delivered the form to Freddie Mac.

Signature of Authorized Representative:
Title:
Date: 04/20/2014

Submission of this form is for informational purposes only. It does not guarantee any contracts will be awarded or ensure "Approved" Vendor status. You will be contacted at Freddie Mac's discretion. Submissions providing products/services not currently sought will be maintained for future consideration.



Please print a copy for your records before submitting this form.