Attachment_C_-_Vendor_Information_Request_Form.pdf

80 KB Posted

Attached to
TRWRP 93 Motor Control Center Replacement
Solicitation number
RFB-TH-0120
Issued by
Los Angeles County, California

About this file

Written by GovTribe AI ·

This is a Vendor Information Request Form issued by West Basin Municipal Water District, a public agency serving 17 cities and nearly one million residents in coastal Los Angeles County, California. The form is designed to collect comprehensive vendor information for contract opportunities, specifically in this instance related to the TRWRP 93 Motor Control Center Replacement project. The document requests detailed company information including legal name, business address, contact details, and identification of authorized signatories with proof of signature authority.

The form requires vendors to disclose certifications relevant to the project, including Small Business Enterprise (SBE) and Local Business Enterprise (LBE) status, with supporting documentation such as business licenses and certification numbers from relevant public agencies. Vendors must also identify representatives authorized to receive executed agreements and provide accounts receivable information with remittance instructions. The form includes compliance verification for the Build America, Buy America (BABA) Act, requiring vendors to confirm that product components are 65 percent domestically sourced if applicable. West Basin's standard payment terms are Net 30 days, and the form authorizes the agency to verify all stated information. The document is dated January 22, 2026, and serves as a prerequisite for vendor participation in West Basin's procurement process.

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Other files

File Type Posted
Attachment_B_-_TRWRP_MCC_Replacement_Bid_Set_Submittal_Drawings.pdf PDF
Attachment_B_-_TRWRP_MCC_Replacement_Bid_Set_Submittal_Drawings.pdf PDF
Attachment_A_-_TRWRP_MCC_Replacement_Bid_Set_Specifications.pdf PDF
Attachment_B_-_TRWRP_MCC_Replacement_Bid_Set_Submittal_Drawings.pdf PDF
Attachment_A_-_TRWRP_MCC_Replacement_Bid_Set_Specifications.pdf PDF
Attachment_C_-_Vendor_Information_Request_Form.pdf PDF
Attachment_C_-_Vendor_Information_Request_Form.pdf PDF
Attachment_A_-_TRWRP_MCC_Replacement_Bid_Set_Specifications.pdf PDF

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VENDOR INFORMATION REQUEST - West Basin Municipal Water District

Yes No

Yes No

Yes No

Entered By: Date: Yes No W-9 Received: Yes No

Email:

Title:

Address 2 (suite, unit, etc.):

Vendor Number:

Verified

SBE & LBE:

FOR PURCHASING ONLY

Email:

List the representative(s) from your organization that would like to receive a copy of the executed agreement:

Title: Print Name:

Print Name:

Email:

COMPANY INFORMATION

Complete Legal Name:

Address 1: Contact Phone:

Which Public Agency are you Certified With?

Certification Number:

Are you a Certified Small Business Enterprise (SBE)? If yes, Small Business certification must be submitted.

ACCOUNTS RECEIVABLE (remittance name and address)

City/State/Zip:

Contact Fax:

Remittance name: Contact Name:

Are you a Local Business Enterprise (LBE)?

If yes, please provide a copy of your business license.

Business License Number:

Address - Same as above

Address 1: Contact Phone:

ADDITIONAL INFORMATION

CONTRACTS/AGREEMENTS INFORMATION

Payment Discounts:

(West Basin terms: Net 30) Contact Email:

List the representative(s) from your organization that will be signing the agreement and attach proof of signature authority. Documentation should state that the representative has the authority to execute contracts—examples of proof: Articles of Incorporation, corporate resolution, written consent, etc.

Title: Print Name:

Title: Print Name:

Email:

Print Name:

Length of time at this address? Contact Email:

By signing, you authorize West Basin to verify the information stated on this form. Signature:

If applicable, do your company's products comply with the Build America, Buy America (BABA) Act?

(Product components are 65% domestically sourced.)

Address 2: Contact Fax:

City/State/Zip:

Title:

1-22-2026

Complete Legal Name:
Length of time at this address:
Business License Number:
Remittance name:
Entered By:
Title:
Certification Number:
Which Public Agency are you Certified With:
Address 1:
Address 2:
Contact Fax:
Contact Phone:
City/State/Zip:
Contact Email:
Contact Name:
Print Name:
Email:
Vendor Number:
Payment Discounts: [NET 30 Days]
Contact Fax 2:
Address 3:
Address 4:
Contact Phone 2:
Contact Email 2:
City/State/Zip Code:
Title 1:
Title 2:
Title 3:
Title 4:
Print Name 2:
Print Name 3:
Print Name 4:
Email 2:
Email 3:
Email 4:
Print Name 1:
Date1_af_date:
Group5: Off
Check Box8: Off

File details come from the government source that posted it. Updated .