1-VENDOR INFORMATION CREATESUPPLIER02112026REV3 (2).pdf

PDF 197 KB Posted

Attached to
iM3 Veterinary Dental Radiography Machine
Solicitation number
SPQ260221
Issued by
Bath County, Kentucky

About this file

This is a Vendor Information/Create Supplier form for Louisville Metro Government, specifically designed for vendors interested in bidding on state and local contract opportunities in Kentucky. The form serves as the initial registration document that vendors must complete to establish themselves in the Louisville Metro procurement system. The form requires vendors to provide comprehensive business information including legal business name, address, contact details for both contract and invoice matters, federal identification numbers, and unique entity identifiers. Additionally, vendors must disclose their ownership status and any applicable business certifications such as Minority Business Enterprise (MBE), Women Business Enterprise (WBE), Disabled Business Enterprise (DIBE), LGBT Business Enterprise (LGBTBE), Veteran Owned Small Business (VOSB), or Service-Disabled VOSB designations, along with race and ethnicity information for classification purposes.

The form is current as of February 11, 2026 (Revision 3) and establishes the procedural requirements for vendor registration and record updates within Louisville Metro Government's Workday system. New suppliers must complete all sections of this form along with an IRS Form W-9 dated within the last 12 months, with submission occurring through the CREATE SUPPLIER REQUEST task. For existing suppliers seeking to update their information, only applicable sections require completion, and the supplier change request process is initiated through Workday. The form includes checkboxes for various certifications, ownership classifications, and demographic categories, enabling vendors to clearly identify their business qualifications and eligibility for set-aside contract opportunities. This standardized registration form is fundamental to all procurement activities with Louisville Metro Government and must be completed before vendors can participate in specific bid opportunities such as the iM3 Veterinary Radiography Machine procurement for the Louisville Metro Zoo.

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3-Specifications.pdf PDF
2-W-9 3-2024.pdf PDF

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Text version

VENDOR INFORMATION / CREATE SUPPLIER

Full Legal Business Name of Proposer:

Address:

City: State: Zip:

E-Mail Address:

Telephone:

Metro Louisville Revenue Commission Number:

Federal ID Number:

Unique Entity Identifier:

The following individual is authorized to submit this proposal on behalf of and enter subsequent negotiations should Louisville Metro Government determine our firm reasonable susceptible of being selected for award.

Contact for Contracts: Contact for Invoices:

Email: Email:

Name: Name:

Phone Number: Phone Number:

Authorized Agent Signature:

Printed Name:

Title:

E-Mail Address:

Date:

Supplier Classification Ownership Status (51% owned or controlled)

Minority-Owned Women-Owned Disabled-Owned LGBT-Owned Non-Profit Not Applicable

Certifications (if applicable) Minority Business Enterprise (MBE) Women Business Enterprise (WBE) Disabled Business Enterprise (DIBE) LGBT Business Enterprise (LGBTBE) Veteran Owned Small Business (VOSB) Service-Disabled VOSB (SDVOSB)

Louisville Metro Human Relations Commission Certification Race / Ethnicity American Indian or Alaska Native Asian American Asian-Indian American Asian – Pacific American Black / African American Caucasian Latino or Hispanic Other

Form Date: 02/11/2026 - REV 3

To Request New Supplier: Suppliers complete all sections of this form along with an IRS Form W-9 dated within the last 12 months. Forms are attached and submitted by LMG in Workday as part of the CREATE SUPPLIER REQUEST task.

To Update / Change to Supplier Record: Suppliers must complete the applicable sections. LMG completes the Workday task CREATE REQUEST; select SUPPLIER CHANGE REQUEST; enter the requested change and attach this completed form

Full Legal Business Name of Proposer:
Address:
City:
State:
Zip:
EMail Address:
Telephone:
Metro Louisville Revenue Commission Number:
Federal ID Number:
Unique Entity Identifier:
The following individual is authorized to submit this proposal on behalf of:
Email:
Email_2:
Name:
Name_2:
Phone Number:
Phone Number_2:
Printed Name:
Title:
EMail Address_2:
Date:
MO: Off
WO: Off
DO: Off
LO: Off
NP: Off
NA: Off
MBE: Off
WBE: Off
DIBE: Off
LGBTBE: Off
VOSB: Off
SDVOSB: Off
AI: Off
AA: Off
AIA: Off
APA: Off
BAA: Off
C: Off
LOH: Off
O: Off

File details come from the government source that posted it. Updated .