REQUIRED_FORMS_-_AAs_-_FOR_INFORMALS.pdf
PDF 171 KB Posted
- Attached to
- Scoreboard Diagnostic and Repair Services
- Solicitation number
- 2025-Informal-0043
- Issued by
- Los Angeles County, California
About this file
This document contains two standard vendor forms from the City of Pasadena Purchasing Division: a Vendor Questionnaire (Form AA-1) and a Licenses and Certifications form. These forms are part of the procurement process for the Scoreboard Diagnostic and Repair Services contract, which requires vendors to provide detailed company information and certify compliance with equal opportunity employment practices. The forms request basic company details, contact information, types of goods and services offered, and optional statistical information about business ownership.
The Vendor Questionnaire requires vendors to declare under penalty of perjury that they adhere to non-discriminatory employment practices and do not maintain segregated facilities. The optional ownership section allows vendors to self-identify their business ownership characteristics, including race, ethnicity, gender, and disability status. The Licenses and Certifications form provides a template for vendors to list required licenses and certifications, with specific mention of a Pasadena Business License, California Department of Industrial Relations registration for public works, and potential Small and Micro Business Certification from the California Department of General Services.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Scoreboard_Diagnostic_and_Repair_Services.pdf | ||
| RELEVANT_EXPERIENCE_FORM.pdf | ||
| Unique_Entity_ID_(SAM).pdf | ||
| Disclosure_of_Lobbying_Activities.pdf | ||
| DoIT_Technical_Questionnaire.xlsx | XLSX spreadsheet |
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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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