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Cherokee Nation TEROTribal Employment Rights Office Certification ApplicationPer Legislative Act 01-04, to be certified as an Indian Owned Business by the Cherokee Nation TERO (TribalEmployment Rights Office), your business must meet these definitions:Section 4. O. “Indian-owned economic enterprise” shall mean any Indian-owned commercial, industrial, or business activity established ororganized for the purpose of profit, provided that such Indian ownership shall constitute not less than 51percent (51%) of the enterprise, and theownership shall encompass active operation and control of the enterprise.Section 4. M. “Indian” shall mean a person who is a member of a federally recognized Indian tribe and/or any person recognized as an Indian bythe United States pursuant to its trust responsibility to American Indians.1. Firm Identification:Federal Identification/Social Security No.Name of FirmDate of ApplicationMailing AddressCityStateZipType of Business: Single ProprietorCorporationLLCPartnershipPercent of Indian Ownership: (Must be 51% or more)Contact NameBusiness PhoneEmailBusiness Fax:Date firm was established: Number of Indian Employees: Non-IndianDirections to business location:PO Box 948 Tahlequah, OK 74465 (918) 453-5334Page 2
Cherokee Nation TEROTribal Employment Rights Office Certification Application2. Capital & Equipment:A.B.QuantityIdentify amount and source of original and present capital (e.g., contributed by owner, bank loan, or othertype of loan) If loan indicate name(s) of those legally bound to repay.Equipment: List all equipment pertaining to day-to-day operations and businessDescriptionPrice (Book value)How Obtained(Purchased, provided by owner, donated, etc.)Applicant may submit equipment list as Attachment - 2PO Box 948 Tahlequah, OK 74465 (918) 453-5334Page 3
Cherokee Nation TEROTribal Employment Rights Office Certification ApplicationDocumentation RequirementsTERO Form C-1Management1. Provide for each owner of more than 5% interest, all senior management personnel and members of the Board of Director the following:A. NameB. AddressC. Social Security NumberD. If Indian, Tribal Affiliation and Enrollment NumberE. Percentage of ownership2.3.4.5.6.7.Present position (description of all duties)Previous business experiencePrevious work experience in areas in which firm intends to engageEducation and TrainingOther jobs presently heldControl of Company:A. Identify nameB. RaceC. SexD. Title in company those individuals (owners and non-owners) who are responsible for day to day management,including, but not limited to, those with prime responsibility for:a. Financial decisionsb. Management decisions, such as: Marketing & Sales Hiring & Firing Purchase of major equipment & supplies Supervision of field personnel8.Describe or attach any stock options or other ownership options that are outstanding, and any agreements betweenowners & third parties, which restrict ownership or control of Indian owners.9. A sworn statement of the proper officer indicating:A. The total number of share of the capital stock actually issued and the amount of cash paid into the treasury on each sharesold: or, if paid in property, the kind, quantity and value of the same per share.B. Of the stock sold, how much remains unpaid and subject to assessment?FORM C-1PO Box 948 Tahlequah, OK 74465 (918) 453-5334Page 4
Cherokee Nation TEROTribal Employment Rights Office Certification ApplicationTERO Form P-1Documentation Requirements1.Provide for each Owner:A. NameB. AddressC. Tribal AffiliationD. Enrollment NumberE. Percent of OwnershipF. Amount of InvestmentG. Method of Investment Cash EquipmentH.Loan information or promissory note indicating who the loan is fromI.Percent of voting control and position in the firmJ.Name of all other firms in which the owner holds or has within the past year an ownership interest (otherthan publicly-held corporations and similar ownerships solely for investment) or a management position.2. List any management fee, equipment rental, bonuses or other arrangements that will provide payment to non-Indianowners beyond their share of profits and salaries, as indicated above.3. Identify any owner or management official of the named company who is or has been an employee of anothercompany that has an ownership interest in or a present business relationship with said company; present businessrelationships include shared space, equipment, financing, or employees as well as both companies having some of thesame owners.4.Indicate if this company or other companies with any of the same officers have previously received or been deniedcertification or participation as an Indian preference firm and describe the circumstances. Indicate the name of thecertifying authority and the date of such certification or denial.FORM P-1PO Box 948 Tahlequah, OK 74465 (918) 453-5334Page 5
Cherokee Nation TEROTribal Employment Rights Office Certification ApplicationCertificationI do solemnly declare and affirm that the contents of the foregoing documents ae true and correct and include allinformation necessary to identify and explain the operation of (Nameof Business), as well as the ownership therof. The undersigned in addition swears that this business is at least 51%owned by one or more members of a federally recognized Tribe whose management and daily business operation arecontrolled by one or more such individuals.Any material misrepresentation will be grounds for denial or revocation or certification by members of the CherokeeNation TERO. By executing this certification I hereby submit to the jurisdiction of the Cherokee Nation Courts.(Signature)(Date)(Print or Type Name)(Title)On this day of , 20 before me appeared applicant, who being duly sworn did execute the foregoing affidavit, and didstate that she/he was properly authorized by(Name of business)To execute the affidavit and did so as her/his free act and deed.(Notary Signature and Seal)(Date)Page 6
Cherokee NationTribal Employment Rights Office Master Skills ListAboveground anufacturing/SalesAccounting amingArt lt/Concrete-StripingAsphalt-PavingAsphalt-Seal CoatingAsphalt-SweepingAsset Inspections-AerialAttorney at LawAuction-GeneralAuthorAutomobile-Body WorkAutomobile-DetailingAutomobile-Emergency Vehicle OutfittingAutomobile-GlassAutomobile-New TiresAutomobile-Used SalesAviation-ServicesBackground ChecksBakeryBankBanquets/EventsBeauty Salon/Barber Shop/SuppliesBeef-ProducerBehavioral Health/CounselingBlueprint ar WashCarpet ockCell TowersCeramic Art lay-Manufacture/Tile/PotteryCoffee-SalesCommunity ta StorageComputer-IT er-Research & DevelopmentComputer-SalesComputer-Software lat ion/Millwork-Trim SalesConstruction-Commercial/General ContractorConstruction-Commercial ManagementConstruction-EIFS (Exterior Insulation Finish Systems)Construction-Inspection ServiceConstruction-Metal BuildingsConstruction-Metal FramingConstruction-Residential/General ContractorPage 17/23/2021
Cherokee NationTribal Employment Rights Office Master Skills sidential -Wood FramingCounter Tops-SalesCourier/DeliveryCrane Rental ServicesCrane ServicesData Storage MediaData Systems-ConsultingDefensive eneral & verhead-SalesDoors-Sales/SuppliesDraftingDrug & Alcohol-AssessmentsDrug Screening/TestingDrywall FinishingDrywall actorElectrical-High gravingEnvironmental & Industrial Odor tialExcavation-MiningExcavation-Site Prep/DemolitionExcavation-Site UtilitiesExcavation-Snow RemovalExcavation-Storm al-InvestmentsFire Equipment-Sales/ServiceFire Restoration & CleaningFire Wood/Pallets-SalesFleet Management MaintenanceFloor Cleaning-Hard Food Concession and CateringFood Custom eG.I.S.-ServiceG.P.S. BraceletsGaming allationGlass-RepairsGlass-SalesGraphic DesignHardware StoreHay Baling/Brush HoggingHead Stone/MemorialsHeavy Equipment-Moving/SettingHeavy Equipment-Sales/Supplies/LeasingHeavy Equipment-ServicePage 27/23/2021
Cherokee NationTribal Employment Rights Office Master Skills ListHealthcare-ConsultingHome es-Party calInsuranceIron Work-Custom/ArtJanitorial-SuppliesJewelryLand Development-CommercialLand Development-ResidentialLand Mapping (Orthomosaic, Topographical-Aerial)Landscaping-Commercial scaping-Residential IrrigationLandscaping-Sod Sales/InstallationLandscaping-SuppliesLaundry-Dry Cleaning/AlterationsLaundry-Industrial LinenLawn & Garden-Supplies/Sales/ServiceLawn Work/MowingLawn lLighting-ResidentialLinen-SalesLitigation Support pliesLocksmith-Rekey/InstallationLumber YardLumber-Sales/SuppliesMachine Job ShopMachine Job Shop-Control PanelsMachinery-Metal nt-ProjectManagement-PropertyMarble/Granite age TherapistMattresses-SalesMedia ServicesMedical-Doctor/SurgeonMedical Equipment-Sales/Service/Install/LeasingMedical Service-Ambulance/NEMT/Supplemental EMTMedical-SuppliesMining PermitsMobile struments/LessonsNatural ffice-Equipment/Supplies/LeasingOil & Gas-ConsultingOil & Gas-SupplierOptometryOutdoor Recreational Products/Playground alsPaint-Supplies/SalesParking Lot StripingPatio-CoversPediatric Sleep-ConsultingPercolations TestPharmacyPhotography/Videography-AerialPage 37/23/2021
Cherokee NationTribal Employment Rights Office Master Skills ListPhotography/Videography-GeneralPipeline Employee ntractorPlumbing-SuppliesPorta PottiesPower printsPrinting-Custom (in house printers only)Printing-FormsPrivate InvestigationProject EstimationPromotional GeriatricPublishingReal Estate-Abstracts/Escrow/Title InsuranceReal Estate-AppraisalReal Estate-ConsultingReal Estate-Rental PropertyReal sbestosRemediation-Lead Base Paint rRestaurantRestaurant/Bar Equipment-Sales/SuppliesRestaurant/CateringRetail Store-Clothing/ClothingRetail Store-FirearmsRoofing-Gravel/Fiberglass ShinglesRoofing-Hot tteringRoofing-SuppliesRoofing-Wood ShinglesSafety TrainingSandblastingSanitary Sewer InstallationSatellites-InstallationScreen Printing (In House)SecuritySecurity-Alarm SystemsSeptic Tank-SalesSeptic Tank-Service/Pumping/InstallationSewage Treatment Plants-Construction/Inspection/EvalSheet ding-VinylSiding-WoodSigns-Billboards/Design & InstallSigns-CommercialSigns-WindowSilk ScreeningsSludge-RemovalSmall Engine-Sales/ServiceSmoke ShopSober Living HomeSoil StabilizationSpeech-TherapySporting GoodsStaffing teel-Stainless Steel FabricationSteel-SuppliesStorage Building/Containers-SalesStorage FacilityStorm Sewer InstallationStorm Shelters/InstallationSurveyingSwimming r-Harvesting/ConsultingPage 47/23/2021
Cherokee NationTribal Employment Rights Office Master Skills ls/ServiceTrash/Refuse CollectionTrash-Dumpsters/ContainersTravel AgencyTree Removal-Stump GrindingTree Removal-TrimmingTrucking Equipment-Sales/ServiceTrucking-Equipment TransportTrucking-Material TransportTruss-MetalTruss-WoodUnderground Lines-TestingUnderground lity-Power LinesVending liesVideo Conferencing-Equipment/ServiceVideo ProductionsVideo SurveillanceWall Paper-InstallationWall Paper SalesWaste Management-Sales/ServiceWater Boiler/Chiller-Sales/ServiceWater Dispenser-Sales/Service/RentalsWater FiltrationWaterline InstallationWaterproofingWater Pump-Sales/ServiceWater-Restoration & ExtractionsWater-Treatment PlantsWater-Treatment ServiceWater-Well DrillingWater-Well-Sales/ServiceWeb Design-InteractiveWebsite Design & E e Control-Animal, Bird, lationWindows-RepairWindows-SuppliesWire RopeWrecker Service/TowingPage 57/23/2021
Tribal Employment Rights Office Certification Application FORM C-1 PO Box 948 Tahlequah, OK 74465 (918) 453-5334 Page 4 Cherokee Nation TERO TERO Form C-1 Documentation Requirements Management 1. Provide for each owner of more than 5% interest, all senior management personnel and members of the Board of Director the following:
