Please complete the form.

Note: It is the responsibility of the Tier 1 supplier to ensure and verify that Tier 2 suppliers are MBE or WBE certified.

Direct Spend

Please enter the $ amount in this format(example: xxxxxxxxxxxx.xx)

$
$
$
$
$
$
$
$
$
$

Indirect Spend

Please enter the $ amount in this format(example: xxxxxxxxxxxx.xx)

$
$
$
$
$
$
$
$
$
$





TIER 2 REPORT

The Tier 2 Report is due to State Farm 30 days following the end of each quarter.

Definitions

Direct Spend is dollars State Farm's supplier spends with Minority Males, Minority Females, Caucasian Females, People with Disabilities, and LGBT suppliers whose products and/or services directly support the products and/or services the supplier is providing to State Farm.

Indirect Spend is dollars State Farm's supplier spends with Minority Males, Minority Females, Caucasian Females, People with Disabilities, and LGBT suppliers whose products and/or services cannot be identified as directly supporting the products and/or services the State Farm supplier is providing to State Farm. For an example, operating supplies, facility or maintenance services.

State Farm's % of your quarterly revenue is calculated by: Total State Farm revenue to supplier in the quarter/Total revenue to supplier from all customers in the quarter.

Example: If State Farm's total revenue to supplier in the quarter is $100, and total revenue to supplier from all customers in the quarter is $500.
100/500 = .20 or 20%