3-VENDOR INFORMATION CREATESUPPLIER02112026REV3.pdf

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Attached to
Via-Smart Project
Solicitation number
IFB260244
Issued by
Bath County, Kentucky

About this file

This is a Vendor Information/Create Supplier form used by Louisville Metro Government (LMG) in Kentucky to establish new supplier relationships or update existing supplier records in their Workday procurement system. The form requires vendors to provide comprehensive business identification information including legal business name, address, contact details, Federal ID Number, and Unique Entity Identifier. The document serves as the foundational registration document for suppliers seeking to do business with Louisville Metro Government and must be submitted along with an IRS Form W-9 dated within the last 12 months when creating a new supplier account or updating an existing supplier record through the CREATE SUPPLIER REQUEST or SUPPLIER CHANGE REQUEST tasks in Workday.

The form includes multiple certification and classification options allowing vendors to self-identify their ownership status, including minority-owned, women-owned, disabled-owned, and LGBT-owned designations, along with relevant 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), and Service-Disabled VOSB (SDVOSB) certifications. The form is revised as of February 11, 2026 (REV 3) and requires designation of authorized representatives for contract and invoice contact purposes, along with the authorized agent's signature, printed name, title, and date. The document does not contain pricing information, specific contract terms, project scope details, or award information, as it functions solely as a supplier registration and qualification document required prior to vendor participation in Louisville Metro Government procurement opportunities.

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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 .