REQUIRED_FORMS_-_AAs_-_FOR_INFORMALS.pdf
PDF 171 KB Posted
- Attached to
- Personal Protective Equipment
- Solicitation number
- 2025-Informal-0004
- Issued by
- Los Angeles County, California
About this file
The documents are Vendor Questionnaire forms (Form AA-1) from the Purchasing Division of the City of Pasadena, located at 100 N. Garfield, Room S348, Pasadena, CA 91101. These forms are part of a solicitation for Personal Protective Equipment (PPE) for Pasadena Water & Power, with the first form being an Affidavit of Equal Opportunity Employment & Non-segregation and the second form focusing on Licenses and Certifications. The forms require vendors to provide company information, certify non-discriminatory employment practices, and list required licenses and certifications for potential contract work.
The forms include optional statistical reporting sections for vendor ownership demographics (such as African American, Asian, Armenian, Hispanic, Native American, Female, or Disabled ownership) and require vendors to review solicitation documents to identify and list necessary licenses or certifications. For this particular PPE procurement, vendors must be prepared to provide documentation from agencies like the City of Pasadena Business License, California Department of Industrial Relations (for Public Works), and the California Department of General Services (for Small and Micro Business Certification). The forms serve as preliminary documentation for potential vendors to demonstrate their qualifications and compliance with local government contracting requirements.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Personal_Protective_Equipment.pdf | ||
| RELEVANT_EXPERIENCE_FORM.pdf | ||
| Unique_Entity_ID_(SAM).pdf | ||
| DoIT_Technical_Questionnaire.xlsx | XLSX spreadsheet | |
| Disclosure_of_Lobbying_Activities.pdf |
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Text version
Purchasing Division 100 N. Garfield, Room S348 Pasadena, CA 91101 Phone (626) 744-6755 https://www.cityofpasadena.net/finance/doing-business-with-the-city/
Vendor Questionnaire (Form AA-1)
Affidavit of Equal Opportunity Employment & Non-segregation
By submitting this form you are declaring under penalty of perjury under the laws of the State of California and the laws of the
United States that the information is true and correct. Furthermore, you are certifying that your firm will adhere to equal opportunity employment practices to assure that applicants and employees are not discriminated against because of their race, religion, color, national origin, ancestry, disability, sex or age. And, your firm does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not and will not permit its employees to perform their services at any location, under its control, where segregated facilities are maintained.
Company Name:
Address:
City, State, Zip:
Contact Person:
Phone:
E-mail Address:
DBA (if applicable):
Remit Address (if different):
City, State, Zip:
Please state clearly and concisely the type(s) of goods and services your company would provide on this contract
The following section is OPTIONAL and is for statistical reporting purposes only. Ownership (please check all that apply):
☐African American
☐Asian
☐Armenian
☐Hispanic
☐Native
American
☐Disabled
☐Female
Purchasing Division
100 N. Garfield, Room S348
Pasadena, CA 91101
Phone (626) 744-6755
Licenses and Certifications
Review the solicitation document to identify the required licenses or certifications, and list them on this form. This form is for quick reference only.
Company Name: __________________________________________________________
Project:__________________________________________________________________
Address: _______________________________________________________________
City, State, Zip: _______________________________________________________________
Phone: _____________________________
Email Address: _________________________________________________________
Agency, and Description Number
City of Pasadena (Pasadena Business License)
State of California, Department of Industrial Relations (Required For all Public Works: Pursuant to Division 2, Part 7, Chapter 1)
State of California, Department of General Services (Small and Micro Business Certification)
License/Certification Name
Issuing Organization Issue Date Status License or Certification Number
| Contact Person: |
| DBA if applicable: |
| Remit Address if different: |
| City State Zip_2: |
| Please state clearly and concisely the types of goods and services your company would provide on this contract: |
| African American: Off |
| Armenian: Off |
| Native: Off |
| Female: Off |
| Asian: Off |
| Hispanic: Off |
| Disabled: Off |
| NumberCity of Pasadena Pasadena Business License: |
| NumberState of California Department of Industrial Relations Required For all Public Works Pursuant to Division 2 Part 7 Chapter 1: |
| NumberState of California Department of General Services Small and Micro Business Certification: |
| LicenseCertification NameRow1: |
| Issuing OrganizationRow1: |
| Issue DateRow1: |
| StatusRow1: |
| License or Certification NumberRow1: |
| LicenseCertification NameRow2: |
| Issuing OrganizationRow2: |
| Issue DateRow2: |
| StatusRow2: |
| License or Certification NumberRow2: |
| LicenseCertification NameRow3: |
| Issuing OrganizationRow3: |
| Issue DateRow3: |
| StatusRow3: |
| License or Certification NumberRow3: |
| LicenseCertification NameRow4: |
| Issuing OrganizationRow4: |
| Issue DateRow4: |
| StatusRow4: |
| License or Certification NumberRow4: |
| Company Name: |
| Address: |
| City State Zip: |
| Phone: |
| Project: |
| Email Address: |
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