Fillable PA UCP NAICS Code Modification Form Date

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PA UCP NAICS Code Modification Form Date

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Moving Pennsylvania forward and
creating economic opportunities for all.
Certifying Participants
City of Philadelphia Port Authority of
Allegheny County
Philadelphia International Airport PENNDOT Allegheny County SEPTA
Department of Minority, Women and Disadvantaged Business Bureau of Equal Office of Equal DBE Program Office
Disadvantaged Business Enterprise Enterprise Program Office Opportunity Opportunity
Request for NAICS Code Modification
The Pennsylvania Unified Certification Program (PA UCP) assigns North American Industry Classification
System (NAICS) codes that correspond to the products and/or services that the Disadvantaged Business
Enterprise (DBE)/Airport Concession Disadvantaged Business Enterprise (ACDBE) can demonstrate it has
previously and/or currently sells or provides (49CFR26.71(n)). The PA UCP will not assign NAICS codes
representing products or services that are subcontracted by the DBE/ACDBE to another business. Please be
advised that your request to add a code is subject to review and your firm must meet the SBA size standards or
the DBE size cap to be eligible.
If the DBE/ACDBE wants to add and/or delete NAICS codes to/from their profile, the disadvantaged owner of
the firm should complete and sign this form and submit it along with verification that the company has, or is
currently providing the products and/or services covered by the requested code(s). The disadvantaged owner
must also demonstrate control with respect to the type(s) of work being requested. Examples of verification
are invoices or copies of contracts, etc.
If a state or federal license is required to sell a product or perform a service, please provide a current copy of the
required license held by the disadvantaged owner.
Requests must be submitted to the PA UCP agency that certified your firm. Contact information can be found
on our website at www.paucp.com.
Please print
Firm’s Name _______________________________________________________________________
Primary owner’s name(s) ______________________________________________________________
Address ___________________________________________________________________________
City ______________________________________ State_______________ Zip_________________
Phone number______________________________ Fax Number _____________________________
Email address______________________________ Website__________________________________
Annual Gross Receipts_______________________ Number of Employees______________________
Page 2
PA UCP
Request for NAICS Code Modification
Please add the following NAICS code(s) to our certification records. Our firm is providing the products and/or
services covered by these codes.
Code #1:___________ Code #2:__________ Code #3:__________ Code #4:_____________
Please remember to attach verification showing that the firm has and/or is providing the products
and/or services.
In lieu of a NAICS code, you may provide a description of goods or services in the space below and our
office will assign the appropriate NAICS code.
Please delete the following NAICS code(s) from our records. We are not interested in being solicited for the
goods or services covered by these codes.
Code #1:___________ Code #2:__________ Code #3:__________ Code #4:_____________
In lieu of a NAICS code, you may provide a description of goods or services in the space below for
which your firm is no longer seeking DBE credit.
Additional sheets may be attached, if needed.
I hereby make the above request and affirm the information I am providing is correct.
Owner/CEO’s Signature________________________________ Date___________________________
*Please note that the PA UCP reserves the right to change your NAICS codes at any time to adequately describe
the kind of work your firm has demonstrated that it can control.
PAUCP rev. 5/2016
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PA UCP NAICS Code Modification Form Date

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Completed 6 July 2020

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