3-VENDOR INFORMATION CREATESUPPLIER02112026REV3.pdf

PDF 197 KB Posted

Attached to
Paving Design Services
Solicitation number
RFP260155
Issued by
Jefferson County, Kentucky

About this file

This is a Vendor Information/Create Supplier form used by Louisville Metro Government in Kentucky for establishing new supplier relationships or updating existing supplier records. The form serves as the foundational documentation for vendors interested in contracting with Metro Louisville for municipal engineering services on an as-needed basis. The contract opportunity encompasses professional engineering services including development plan review, planning, estimating, design, field surveys, construction document preparation, right-of-way and easement acquisition, construction administration and inspection, and public works project design. Qualified firms must also be capable of providing or coordinating surveying, landscape architectural design, geotechnical analyses, construction management, and environmental reviews.

The form requires vendors to provide complete business identification information, including legal business name, address, Federal ID Number, and Unique Entity Identifier, along with designated contacts for both contracts and invoicing purposes. Vendors must indicate their ownership classification and 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 status, as well as race and ethnicity for demographic tracking purposes. New suppliers must submit the form along with an IRS Form W-9 dated within the previous twelve months, while existing suppliers need only complete applicable sections for record updates. The form is processed through Louisville Metro Government's Workday system and is effective as of February 11, 2026 (Revision 3).

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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 .