5-Supplier Create Form.pdf
PDF 248 KB Posted
- Solicitation number
- RFP260071
- Issued by
- Bath County, Kentucky
About this file
The document is a Create/Update Supplier Form from the Louisville Metro Government's Office of Management & Budget, dated March 2023. The form is designed for suppliers to either create a new supplier record or update an existing one in the city's Workday system. It requires suppliers to complete sections detailing their company information, including basic contact details, federal identification numbers, address information, and supplier group classification.
The form includes sections for supplier classification and certifications, allowing businesses to self-identify their ownership status (such as minority-owned, women-owned, disabled-owned, or LGBT-owned) and various certification types through the Louisville Metro Human Relations Commission. These classifications can help businesses qualify for specific procurement opportunities or meet diversity and inclusion requirements. The document also provides an authorization section where a representative can affirm the accuracy of the submitted information, with space for signature, contact information, and date of submission.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2-Ban the Box Compliance Checklist.pdf | ||
| 1-Acknowledgements Preferences.pdf | ||
| 9-Submission Instructions - RFP260071.pdf | ||
| 7-RFP260071 Work Plan.pdf | ||
| 6-W9.pdf | ||
| 3-GFE Docs.xlsx | XLSX spreadsheet | |
| 8-RFP260071 Specifications.pdf | ||
| 4-Info Signatures-RFP.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Louisville Metro Government Office of Management & Budget
Create / Update Supplier Form 3/2023
Create / Update Supplier Form Instructions Form is optional for Non-Procurement Suppliers.
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
Section 1: Supplier Information Supplier Name (Company or Individual) Alternate Name / DBA
Federal Employer ID (TIN/EIN) or Social Security Number TIN/EIN
SSN
Fed Unique Entity Identifier (if applicable) Phone Number Contact First Name Contact Last Name Email Address Address Line 1 Address Line 2 City State Postal Code Remit to Address (if different from above) Address Line 1 Address Line 2 City State Postal Code Supplier Group: Select the group(s) that best describe the type of supplier
Goods and Non-Professional Services Construction Professional Services Non-Procurement
Section 2: Supplier Classification Ownership Status (51% owned or controlled)
Minority-Owned Women-Owned Disabled-Owned LGBT-Owned Non-Profit Not Applicable
Section 3: Certifications (if applicable) Louisville Metro Human Relations Commission Certification Type
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
Section 4: Authorization By my signature below, I affirm that the organization has authorized me to disclose the information contained herein and hereby further affirm that said information is accurate to the best of my knowledge and belief.
Representative Signature Phone:
Representative Printed Name Date:
Second Chance Supporting Business
| Supplier Name Company or Individual: |
| Alternate Name DBA: |
| TINEIN: |
| SSN: |
| Fed Unique Entity Identifier if applicable: |
| Phone Number: |
| Contact First Name: |
| Contact Last Name: |
| Email Address: |
| Address Line 1: |
| Address Line 2: |
| City: |
| State: |
| Postal Code: |
| Address Line 1_2: |
| Address Line 2_2: |
| City_2: |
| State_2: |
| Postal Code_2: |
| Supplier Group Select the groups that best describe the type of supplierRow1: |
| Goods and NonProfessional Services: |
| Construction: |
| Professional Services: |
| Ownership Status 51 owned or controlledRow1_2: |
| MinorityOwned: |
| WomenOwned: |
| Ownership Status 51 owned or controlledRow2_2: |
| LGBTOwned: |
| NonProfit: |
| Louisville Metro Human Relations Commission Certification TypeRow1: |
| Minority Business Enterprise MBE: |
| Women Business Enterprise WBE: |
| Louisville Metro Human Relations Commission Certification TypeRow2: |
| LGBT Business Enterprise LGBTBE: |
| Veteran Owned Small Business VOSB: |
| Louisville Metro Human Relations Commission Certification Race EthnicityRow1: |
| American Indian or Alaska Native: |
| Asian American: |
| AsianIndian American: |
| Louisville Metro Human Relations Commission Certification Race EthnicityRow2: |
| Black African American: |
| Caucasian: |
| Latino or Hispanic: |
| Representative Signature: |
| Phone: |
| Date: |
| Check Box2: Off |
| Check Box3: Off |
| Check Box4: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Check Box9: Off |
| Check Box10: Off |
| Check Box11: Off |
| Check Box17: Off |
| Check Box18: Off |
| Check Box19: Off |
| Check Box20: Off |
| Check Box21: Off |
| Check Box22: Off |
| Check Box23: Off |
| Check Box24: Off |
| Check Box25: Off |
| Check Box26: Off |
| Date27_es_:signer:date: |
| Name28_es_:signer:fullname: |
| Check Box15: Off |
| Check Box13: Off |
| Check Box14: Off |
| Check Box16: Off |
| Check Box12: Off |
File details come from the government source that posted it. Updated .