Vendor Registration Form - ArcelorMittal Mexico

Materials Department
Arcelormittal Lazaro cardenas, S.A. de C.V.

Fco. J. Mujica No. 1-B, Apartado Postal No. 19-A

Cd. Lazaro Cardenas, Michoacan Mexico C.P. 60950
Please note that form must be complete in all respects for it to be evaluated.
Please sign the and seal this document in the place indicated in bottom of format. It will not be considered for evaluation in case it is recieved unsigned

in case you do not have or want to share some information requested in the form please mention not- availiable, not applicable or confidential
1.

Name of the Company (As it appears in Acta Constituva)

Imerys Steelcasting USA, Inc.

2.

Full Postal Address

P.O. Box 368, Niagara Falls, NY 14302 UA

Street

4111 & 4113 Witmer Road

City

Niagara Falls

District

NY

Postal Index

14305

Country

USA

Telephone

716-278-1630

Fax

716-284-8753

e-mail

shelley.daloise@imerys.com

Website

www.imerys.com

Business language

English

Business currency

American Dollar

Name and details of direct contact person from your company for ArcelorMittal Mexico
Ing. Pedro Flores Vega via email pflores@kmemexico.com

Specify nature of relationship of your company with above named person e.g. Authorised representative, Employee, Dealer etc.
Authorized Representative
4

Name and Contact details of key person in your organisation e.g. Sales Director, CFO, CEO etc.
Daniel Willman. Director via email daniel.willman@imerys.com or cell 901-628-8714

Organisation structure of your company

Number of employees
Mgmt

Skilled

Unskilled

15

49

Total

70

Are you an ex-employee of ArcelorMittal

No

Are you a close relative (e.g. Father,Mother,Son or Daughter) of a current employee of ArcelorMittal

No

in case yes please specify the nature of relationship

8

Please provide details of any other company already registered with ArcelorMittal
a) where the suppliers or his close relative is owner/ holds a management /director position
b) the company already registered has substantial holding in the supplier's company or vice versa

Financial and Other Details

Total annual turnover ($) last year and year before (please attach the copy of the last 2-annual reports): $35 Million Turnover
Nature of business

Manufacturer

Pattern of business holding

Public

Name of owners in case of proprietorship

Name of the parent company

Imery\s

Tax ID / RFC Number

16-1219541

Income Tax registration year

Details of last 2 income tax returns (pls attach the copies)
Bank information: Name, full address, account number(s), SWIFT code
Any previous experience with ArcelorMittal ?
(If yes - indicate year of interaction and details)
Your turnover for last two years for the range of product offered

M&T Bank, 750 Main Street, Niagara Falls NY USA ABA 022000046 Account 143909 Swift MANTUS33

Yes
2015 / Sales
2013 - 8 Million / 2014 - 8.2 Million / Year to Date - 6 Million

In case rated by International rating agencies e.g D & B please provide details

10

List your top five customers in order of business volume

Name, location of the customer, Contact details

Nucor

ArcelorMittal

Annual busines, $

% of your total business

US Steel

d
e

Whether you would like us to contact your customers

11

No

List your top five suppliers in order of business volume

Name, location of the supplier Contact details

Annual busines, $

% of your total business

Imerys

b
c
d
e

Whether you would like us to contact your suppliers

12

No

Details of product range / services offered: Mold Flux, Tundish Flux, Bottom Pour, and all other covering compounds.
(Attach approval/ authorisation for dealing in products in case not manufacturer or where required by law, norms, standard )

For Arcelormittal to do a complete evaluation it is necessary that you do not leave any part of the format blank
Please check that you have filled / commented in all the requested columns in above format.
please provide the neccessary supporting documents as listed below for the type of your business.

13

Details of quality certification e.g ISO 9000 etc. and year of reciept
Lloyd's Register Approval Certificate No: PIR6018079 / Z-1 Approved 30 December 2013 / Expiry 29 December 2016

14

Details of your associates/authorised dealers in case you deal through them

Note :
1. Please feel free to enclose any other detail which you may think necessary for your assessment
2. The information sought is only for the purpose of vendor registration and evaluation as per procedures of ArcelorMittal . It shall not be used for any other purpose.
3 ArcelorMittal reserves the sole right to accept or reject the form of Vendor registration without any reference, protest or contest. Filling up this form does not assure
you of any share of business.
4. Vendor shall notify the buyer of :
Any *Current or Former Buyer's Employee or Relative who has an ownership interest in Vendor (unless Vendor is a publicly traded company) or who will provide
personal or technical services or services on Buyers premises in connection with Order to be executed by Vendor. Vendor shall obtain Buyers prior written approval for
any Current or Former Buyer's Employee or Relative whom Vendor will use to sell or market goods or services to Buyer. Buyer shall have the right in its sole discretion
* A "Current or Former Buyer's Employee or Relative" means any person who is currently or was within the past three (3) years a salaried, non-represented employee of
any ArcelorMittal company (a "Current or Former Employee") and any person who is a parent, child, sibling or current spouse of a Current or Former Employee and any
close relative.

Declaration
I have read and understood the terms and conditions of Vendor Registration Form and the information provided is correct as per my knowledge and records

Signature with Full Name and designation

Official Seal

CHECK LIST OF DOCUMENTS

* Please indicate in status column YES / NO if you are able or not able to submit the required document.
If You have answered NO please indicate reason

STATUS*

Individual

Limited Company /Partnership

SI/NO

SI/NO

Tax Registration Certification - RFC ( in case of Mexico Supplier)

Ref: 1

Address verification document (in case not same as mentioned in Tax ID/RFC)
Ref: 2

Ref : 3

ID Proof of the main contact person of the supplier /Power of Attorney in case of agent/legal
representative
Last two year Annual tax declarations (ISR for Mexico Supplier)

Ref : 5
Ref: 9 Memorandum of Incorporation (Acta Constitutiva for Mexico Suppliers)

SI/NO

SI/NO

SI/NO

General information of supplier ( type of products or business)

Ref: 9

SI/NO

SI/NO

Details of bank account

Ref: 9

Organisation structure of the Holding Company

Ref: 9

SI/NO

Initial Registration with ISR - only in case of Mexico Supplier

Ref: 9

SI/NO

Latest Certified Bank statement / Crossed Cheq / Certificate from Bank for verification of bank
Ref: 9 account
Organisation structure

SI/NO

Ref : 5

SI/NO

SI/NO

NOTE: The Supplier should comment/ provide reason if any of the above documents/ declaration is not available.

For Internal use:

Capability Assesment
Note: See Attached form For vendor to be considered for order value more than USD 1,000,000.00

Comments from Technical Department:

Signature:

Comments from Materials Department:

Signature:

Comments from Finance Department:

Signature:

Director (Materials)