Environmental Protection Agency 

EPA DBE Certification Application 

For a Minority Business Enterprise (MBE)/Women-owned Business Enterprise (WBE) 

Under EPA’s Disadvantaged Business Enterprise (DBE) Program

Tribally Owned Businesses

Name of Indian tribe:_______________________________________________________________ 

Address of tribe:___________________________________________________________________ 

Name of wholly-owned 

Subsidiary (if applicable):____________________________________________________________ 

Address of wholly-owned 

Subsidiary:_______________________________________________________________________ 

Name of applicant firm:____________________________________________________________ 

Applicant concern is: Corporation Limited Liability Company Partnership 

Name of President/Managing Member/Managing Partner:_______________________________ 

EIN:_________________________ E-mail Address:______________________________________ 

Business Address:______________________________________________ County:_____________ 

City:_________________________________ State:_______________ Zip Code:________________ 

Phone Number:___________________________ Fax Number:______________________________ 

Mailing Address (if different than above):________________________ County:________________ 

City:_________________________________ State:_______________ Zip Code:________________ 

What is the firm’s 4-digit primary North American Industrial Classification (NAIC) code? 

__________________________________________________________________________________ 

Is your firm certified by the Small Business Administration under its 8(a) Business Development 

Program? ___ Yes ___ No. If yes, provide Pro-Net number:________________________________ 

Is your firm certified by the Small Business Administration under its Small Disadvantaged 

Business (SDB) Program? ___Yes ___No. If yes, provide Pro-Net number: ____________________ 

Is your firm certified as a DBE by a U.S. Department of Transportation recipient? ___ Yes ___ 

No. If yes, provide State(s) and ID number(s): _________________________________________ 

EPA DBE Certification Application (EPA Form 6100-1f) 

(Tribally Owned Businesses) 

OMB Control No: 2090-0030 

Approval Expires: XX/XX/XX
Is your firm certified by a State government, local government, Indian tribal government, or

independent private organization? ___ Yes ___ No. If yes, provide ID number and the certifying

entity: ____________________________________________________________________________ 

Has your firm ever been denied certification by a Federal agency, State government, local 

government, Indian tribal government, or independent private organization? ___ Yes ___ No. If

yes, provide 

explanation/documentation:____________________________________________________________ 

_____________________________________________________________________________________ 

Do you have any other certification as a disadvantaged business entity, i.e., MBE, DBE, WBE, etc? 

 ___Yes ___ No. If yes, provide State(s) and ID number(s): ________________________________ 

Is the applicant firm a for profit business? ___ Yes ___ No. 

Do the tribe’s articles of incorporation/ articles of organization/ partnership agreement contain 

express sovereign immunity waiver language or a “sue and be sued” clause which designates

United States Federal Courts to be a competent jurisdiction for all matters relating to EPA’s DBE 

Program? ___ Yes ___ No. If yes, provide a complete copy of the documentation as attachment 

D-3.

 

EPA DBE Certification Application (EPA Form 6100-1f)

(Tribally Owned Businesses)

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Business Eligibility 

SECTION A 

Social Disadvantage 

1. An Indian tribe that meets the following criteria is considered socially disadvantaged:

Indian tribe means any Indian tribe, band, nation, or other organized group or community of

Indians which is recognized as eligible for the special programs and services provided by the 

United States to Indians because of their status as Indians, or is recognized as such by the 

State in which the tribe, band, nation, group or community resides.

Provide documentation that the applicant entity meets these criteria as Attachment A-1. 

2. Provide copies of the tribe’s articles of incorporation and bylaws as filed with the organizing 

or chartering authority, or similar documents needed to establish and govern a non-corporate

legal entity as Attachment A-2. 

SECTION B 

Economic Disadvantage

1. Has the tribe previously established economic disadvantage to qualify as DBE? 

___ Yes ___ No. If yes, provide documentation to verify disadvantaged status as Attachment

B-1. 

 If no, respond to the following questions as Attachment B-2: 

a) What is the number of tribal members on tribal rolls as of the date of application?

b) What is tribe’s present unemployment rate? 

c) What is the per capita income of tribal members excluding judgment awards? 

d) What is the percentage of the local Indian population below the poverty level? 

e) What is the total tribal income for the applicant tribe? 

f) What are the tribe’s assets as disclosed in a tribal financial statement?

g) Provide a list of all wholly or partially owned tribal enterprises or affiliates and

the primary industry classification of each. The listing should include the 

members of the tribe who manage or control such enterprises by serving as

officers or directors.

2. The Indian Tribe must also submit the following documentation to substantiate a claim of

economic disadvantage:

a) A copy of all governing documents such as the tribe’s constitution or business 

charter. 

b) Evidence of its recognition as a tribe eligible for the special programs and

services provided by the United States or by its state of residence.

EPA DBE Certification Application (EPA Form 6100-1f)

(Tribally Owned Businesses)

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SECTION C 

Ownership

Corporations Only: 

1. Does the tribe firm own at least 51% of the voting stock? ____ Yes ____ No. Please provide 

documentation as attachment C-1.

2. Does the tribe own at least 51% of the aggregate if all classes of stock? ___ Yes ___ No. 

Please provide documentation as attachment C-2.

3. If more than one class of stock, provide information for each class:

 Voting Non- Total

 Voting

a) Total number of shares authorized: _____ ______ ______ 

b) Total number of shares currently outstanding: _____ ______ ______ 

Non-Corporate Entities Only: 

4. Does the tribe own at least 51% interest in the firm? ___ Yes ___ No. Please provide 

documentation as attachment C-3.

5. If more than one class membership interest, provide information for each class:

 Voting Non- Total

 Voting

a) Total number of memberships authorized: _____ ______ _____ 

b) Total number of memberships currently outstanding: _____ ______ _____ 

For Corporate and Non-Corporate Entities: 

6. Does the tribe currently own 51% or more of another firm under the same primary NAIC

code? ___ Yes ___ No. 

7. Within the last two years has the tribe owned 51% or more of another firm under the same

primary NAIC code as the applicant? ___ Yes ___ No. 

SECTION D 

Control and Management

1. Are the management and daily business operations of the tribe controlled by the tribe through 

one or more disadvantaged individual members who possess sufficient management 

experience of an extent and complexity to run the concern? ___Yes ___No. If yes, provide 

documentation to verify tribal membership and management competency as Attachment D-1.

EPA DBE Certification Application (EPA Form 6100-1f)

(Tribally Owned Businesses)

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2. Is the management of the tribe controlled by committees, teams, Boards of Directors, or one

or more members of an economically disadvantaged tribe? ___ Yes ___ No. Please provide 

documentation as attachment D-2.

Management may be provided by non-tribal members if it is determined that such

management is required to assist the concern’s development, provided that the tribe will 

retain control of all management decisions common to Boards of Directors, including 

strategic planning, budget approval and the employment and compensation of officers.

However, a written management development plan must exist which shows how 

disadvantaged tribal members will develop managerial skills sufficient to manage the 

concern or similar tribally-owned concerns in the future. 

3. Are members of the management team, business committee members, officers, and directors 

engaged in any outside employment or other business interests which conflict with the

management of the tribe? ___ Yes ___ No. 

4. List the titles of all officers, directors, management members, partners and key managers and

the hours devoted, by such individual(s) to the management of the tribe. 

Name Title Hours

 ____________________________ _______________________________ __________ 

 ____________________________ _______________________________ __________ 

 ____________________________ _______________________________ __________ 

 ____________________________ _______________________________ __________ 

5. List the names of all individuals who have access to the tribe’s bank account.

Name Title

 ___________________________ __________________________ 

 __________________________ __________________________ 

__________________________ __________________________

 __________________________ __________________________

EPA DBE Certification Application (EPA Form 6100-1f)

(Tribally Owned Businesses)

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Each person signing below: 

1. Certifies that the information provided with regard to the applicant firm’s social and

economic disadvantaged status is true, accurate, and complete to the best of his/her

knowledge and belief.

2. Certifies that the information provided with regard to the applicant firm’s ownership and

control status is true, accurate, and complete to the best of his/her knowledge and belief.

3. Certifies that the information provided with regard to his/her individual disadvantaged

status is true, accurate, and complete to the best of his/her knowledge and belief.

4. Certifies that the information provided, including that shown on documents

accompanying this application, is true, accurate, and complete to the best of his/her

knowledge and belief.

5. Acknowledges that EPA, at its discretion, may give the information submitted to Federal,

state, and local agencies to determine violations of law.

6. Acknowledges that EPA’s approval of an application does not affect the Government’s

right to pursue criminal prosecution for incorrect or incomplete information given on the

application form, even if correct information has been included in other materials

submitted to EPA.

Name SSN Date 

________________________ _______________________ ______________________ 

________________________ _______________________ ______________________ 

________________________ _______________________ ______________________ 

________________________ _______________________ ______________________ 

The public reporting and recordkeeping burden for this collection of information is estimated to average 

1 hour per response. Send comments on the Agency's need for this information, the accuracy of the 

provided burden estimates, and any suggested methods for minimizing respondent burden, including 

through the use of automated collection techniques to the Director, Collection Strategies Division, U.S. 

Environmental Protection Agency (2822T), 1200 Pennsylvania Ave., NW, Washington, D.C. 20460. 

Include the OMB control number in any correspondence. Do not send the completed form to this 

address

EPA DBE Certification Application (EPA Form 6100-1f) 

(Tribally Owned Businesses) 

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