Attachment_C_-_Vendor_Information_Request_Form.pdf
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
This is a Vendor Information Request Form issued by West Basin Municipal Water District for the TRWRP 93 Motor Control Center Replacement project. The form collects comprehensive vendor details including company legal name, business addresses, contact information, and certification status. Vendors must complete sections documenting Small Business Enterprise (SBE) and Local Business Enterprise (LBE) certifications, along with proof of signature authority for contract execution. The form requires identification of representatives authorized to receive executed agreements and sign on behalf of the organization, supported by documentation such as Articles of Incorporation or corporate resolutions. Additional requirements include W-9 receipt verification, business license numbers for LBE-certified vendors, and confirmation of Build America, Buy America Act compliance for applicable products with 65 percent domestic sourcing. The form authorizes West Basin to verify all submitted information and is dated January 22, 2026.
The vendor information form establishes standard payment terms of Net 30 days and collects remittance details for accounts receivable processing. Vendors may indicate eligibility for payment discounts, though West Basin's standard terms remain Net 30. The form accommodates multiple addresses, contacts, and signatories to support vendors with complex organizational structures or multiple operating locations. Completion and submission of this form is a prerequisite for bid consideration on the TRWRP 93 Motor Control Center Replacement project, which requires successful bidders to hold valid California Contractors' License Class C credentials and comply with prevailing wage and certified payroll submission requirements.
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Text version
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 .