23-Vendor Identification Form.pdf
PDF 322 KB Posted
- Attached to
- Miscellaneous Construction Via Job Order Contracting for Los Angeles World Airports (Personal Services)
- Solicitation number
- 0051-2024-07-RFP-228194
- Issued by
- Los Angeles County, California
About this file
This is a Vendor Identification Form used by Los Angeles World Airports (LAWA) for vendor registration and certification purposes. The form requires vendors to provide comprehensive business information including entity type, business address, contact details, and IRS taxpayer identification. Vendors must complete all fields and certify that the provided information is accurate, with an obligation to notify the Strategic Sourcing Division of any changes during the contract term. The form serves as the foundational documentation for vendors seeking to participate in LAWA procurement opportunities, including the Job Order Contracting (JOC) opportunity for miscellaneous construction at LAX and VNY airports with an estimated combined contract value of $6,000,000 over a three-year term.
The form requires vendors to submit supporting certifications based on their business classification, including California Franchise Tax Board forms, City of Los Angeles Business Tax Registration Certificates, and IRS W-9 documentation. Vendors must identify their applicable business designations such as Disadvantaged Business Enterprise (DBE), Minority Business Enterprise (MBE), Women Business Enterprise (WBE), Small Business Enterprise (SBE), Local Business Enterprise (LBE), or other applicable certifications. The form also collects information regarding whether vendors provide healthcare, medical, or legal services, which may trigger additional compliance requirements. All vendors are required to establish a remittance address and designate an authorized representative to execute the certification, ensuring accountability and compliance with LAWA's administrative requirements throughout the contract duration.
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Text version
VENDOR IDENTIFICATION FORM
ALL FIELDS MUST BE COMPLETED. INCOMPLETE FORMS MAY BE REJECTED AND RESUBMITTED.
GENERAL INFORMATION
Entity type (code)
Individual/Proprietor (I)
Corporation (C or S)
Partnership (P)
BUSINESS ADDRESS
Fax
Airport Concessions Disadvantaged Business Enterprise (ACDBE)
Disadvantaged Business Enterprise (DBE)
Disabled Veteran Business Enterprise (DVBE) (LAWA)
Local Business Enterprise (LBE)
Minority Business Enterprise (MBE)
Minority Women Business Enterprise (M/WBE)
Small Business Enterprise* (Proprietary)
Local Small Business (LSB) (formerly SLB)
Women Business Enterprise (WBE) *Per SBA or DGS criteria verification
CERTIFICATION
The undersigned declares and certifies that all statements on this form are true and correct. I agree to notify Strategic Sourcing Division immediately of any changes to the information contained herein. I have read and agreed with the administrative requirements set for this project and have been provided as a checklist in the bid/proposal package. If selected, I/We will comply with these requirements for the duration of the contract.
DateAuthorized Signature
Title
For instructions and additional information, please click LAWA, call 424-646-5380, or email Los Angeles World Airports Procurement Services Division at procurementrequirements@lawa.org
Form VIF 04082025 LM
For LAWA use only:
Contact Person:
F-590 F-589F-588
BUSINESS CERTIFICATION
(Check all that apply - If required, attach copies of all applicable certifications)
F-587
Phone No:
CALIFORNIA FRANCHISE TAX BOARD (FTB)
Click FTB Publication 1017 for further information
City of Los Angeles Office of Finance (OOF) BTRC/VRN No.
Government
LLC (enter entity code below) BTRC/VRN application pending (attach proof of submission)
An FTB form is required from all vendors with a payment address outside of California. Submit form 587 or 590 or proof of submission of form 588 or 589:
For foreign vendors, click Foreign Entity for related instructions
Legal Name
IRS Taxpayer ID No.
(EIN or SSN)
Doing Business As (DBA)
If applicable:
CA SOS Entity/Registration No.
For further information click Office of Finance
Contact Street
Phone
EIN - Employer Identification number SSN - Social Security Number
Print Name
Submit IRS W9 form (required)
SOS - California Secretary of State VRN - Vendor Registration Number
Zip Code
City
State/ Region
Remittance address:Country
Legend:
BTRC - Business Tax Registration Certificate DTFA - California Department of Tax & Fee Administration
CA DTFA Seller Permit No.
(If different from above)
Is the vendor providing healthcare/medical or legal services?
Requesting Division:
https://www.lawa.org/en/lawa-businesses/lawa-administrative-requirements https://www.ftb.ca.gov/forms/misc/1017.html?_sm_au_=isV6qr3j1DZSWN7sFVjLLLQ6vMVN1 https://finance.lacity.org https://www.irs.gov/forms-pubs/about-form-w-9 https://www.irs.gov/forms-pubs/about-form-w-8 https://www.irs.gov/forms-pubs/about-form-w-9 https://www.sos.ca.gov/business-programs/business-entities?adlt=strict https://www.cdtfa.ca.gov/taxes-and-fees/faqseller.htm www.lawa.org/en/lawa-businesses/lawa-administrative-requirements or further information
| Corporation: Off |
| Partnership: Off |
| Governmental Entity: Off |
| Other specify: Off |
| BTRCVRN application pending please attach the application: Off |
| Street Suite: |
| Contact Person: |
| City: |
| Remittance address if required and different from the above: |
| Minority Business Enterprise MBE: Off |
| Small Business Enterprise according to SBA criteria: Off |
| Disadvantaged Business Enterprise DBE: Off |
| Airport Concessions Disadvantaged Business Enterprise: Off |
| Small and Local Business Enterprise SLB: Off |
| Requesting Division: |
| Doing Business As: |
| Legal Name: |
| Phone: |
| Fax: |
| State: |
| Zip Code: |
| Date: |
| Title: |
| Print Name: |
| Specify entity type: |
| EIN OR SSN: |
| Seller Permit Number: |
| Email: |
| Individual Sole Proprietor: Off |
| 590: Off |
| 588: Off |
| 587: Off |
| Contact Person_2: |
| Phone No: |
| License or Reg: |
| Form 589: |
| BTRC No: |
| Authorized Signature: |
| WomanOwned Business Enterprise WBE: Off |
| Minority Women Business Enterprise MWB: Off |
| Yes/No: Yes/No |
| Country: |
File details come from the government source that posted it. Updated .