1-VENDOR INFORMATION CREATESUPPLIER02112026REV3.pdf

This is a Vendor Information/Create Supplier form used by Louisville Metro Government in conjunction with the Jefferson County Clerk's Office solicitation for Employee Benefits Broker and Consulting Services in Kentucky. The form serves as the initial registration document for vendors seeking to provide professional consulting and brokerage services related to employee health and welfare benefit programs for County employees and eligible dependents. The form requests comprehensive vendor information including legal business name, address, contact details, federal identification numbers, and designation of authorized representatives for contract negotiations and invoicing purposes. No specific response dates, due dates, site visits, or bidder conferences are detailed within this vendor registration form, as it functions primarily as a supplier qualification and registration instrument rather than a project-specific solicitation document.

The form includes sections for vendors to identify their ownership status and applicable certifications, including minority-owned, women-owned, disabled-owned, LGBT-owned, and veteran-owned business classifications, as well as certifications such as MBE, WBE, DIBE, LGBTBE, VOSB, and SDVOSB designations. Vendors must submit the completed form along with an IRS Form W-9 dated within the last twelve months as part of the CREATE SUPPLIER REQUEST process in Workday. The form is dated February 11, 2026 (Revision 3) and establishes the baseline vendor data necessary for Louisville Metro Government to evaluate proposals and conduct subsequent contract negotiations. No pricing, set-asides, funding amounts, or contract term information is contained within this vendor registration form.