Vendor_Information_Form_Filled.pdf
PDF 2 MB Posted
- Attached to
- Lightcast - Analyst - Local Data (Developer)
- Solicitation number
- B2727737
- Issued by
- Pennsylvania
About this file
This Vendor Information Form was completed in connection with a micro purchase opportunity for Lightcast - Analyst - Local Data (Developer) services with the City in Pennsylvania. The form documents vendor qualifications and administrative information relevant to the procurement process. The micro purchase will be awarded as a whole or by line item, whichever serves the City's best interest, to the lowest responsive and responsible bidder. Sellers must quote all items to be eligible for award consideration, and no delivery or services should commence until formal notification is received from the department.
The form captures essential vendor details required for evaluation and contract administration purposes. Pricing terms will be determined through the competitive bidding process, with award contingent upon vendor responsibility and responsiveness. The procurement follows standard micro purchase procedures applicable to state and local government contracts in Pennsylvania, ensuring competitive solicitation and compliance with purchasing regulations.
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Text version
Vendor Information Form CITY OF PHILADELPHIA - Procurement Department
1401 JFK Blvd. Room 170B - Philadelphia, PA 19102-1685 www.phila.gov/procurement (215) 686-4720 or 4755
PLEASE COMPLETE THE INFORMATION REQUESTED ON THIS FORM
EMAIL THIS FORM AND YOUR W-9 TO PHLContracts@phila.gov
By submitting this form, you verify that all information submitted to the City of Philadelphia is true and correct and you are notified that submission of false information by you is subject to the penalties of 18 Pa.C.S Section 4904 relating to unsworn falsification to authorities.
Name of Business:
Federal Tax ID #:
MAILING ADDRESS: (FOR BIDS & PURCHASE ORDERS) PHYSICAL ADDRESS ONLY, NO P.O. BOXES
Address Line 1:
Address Line 2:
City/State/Zipcode:
Contact Name:
Phone Number:
Fax Number:
Email Address:
Web Address:
PAYMENT ADDRESS: (IF DIFFERENT FROM ABOVE)
Address Line 1:
Address Line 2:
City/State/Zipcode:
Contact Name:
Phone Number:
Fax Number:
Are you registered with the City of Philadelphia's Office of Economic Opportunity (OEO)?
Select OEO Certification Type: MBE WBE MWBE DSBE
Certification #:
Are you registered on PHLContracts? Yes No
Are you registered as a small business with System for Award Management (SAM)?
Yes No
Yes No
Vendor Information Form CITY OF PHILADELPHIA - Procurement Department
1401 JFK Blvd. Room 170B - Philadelphia, PA 19102-1685 www.phila.gov/procurement (215) 686-4720 or 4721
CORPORATE HEADQUARTERS (IF DIFFERENT FROM ABOVE)
Address Line 1:
Address Line 2:
City/State/Zipcode:
Contact Name:
Phone Number:
Fax Number:
FORM COMPLETED BY: PHONE NUMBER:
EMAIL THIS FORM AND YOUR W-9 TO PHLContracts@phila.gov
| Name of Business: Economic Modeling, LLC |
| Address Line 1: 232 N Almon St |
| Address Line 2: |
| CityStateZipcode: Moscow, ID 83843 |
| Contact Name: Gayathri GV |
| Phone Number: 208.883.3500 |
| Fax Number: |
| Email Address: AR@lightcast.io |
| Web Address: www.lightcast.io |
| Address Line 1_2: Economic Modeling, LLC, |
| Address Line 2_2: P.O. Box 73710 |
| CityStateZipcode_2: Dallas, TX 75373-7104 |
| Contact Name_2: Gayathri GV |
| Phone Number_2: 208.883.3500 |
| Fax Number_2: |
| Address Line 1_3: |
| Address Line 2_3: |
| CityStateZipcode_3: |
| Contact Name_3: |
| Phone Number_3: |
| Fax Number_3: |
| FORM COMPLETED BY: Gayathri GV |
| PHONE NUMBER: 208.883.3500 |
| Check Box2: Yes |
| Check Box3: Off |
| Check Box4: Yes |
| Check Box5: Off |
| Check Box6: Yes |
| MBE: Off |
| WBE: Off |
| Check Box1: Off |
| MWBE: Off |
| DSBE: Off |
| Federal Tax ID: 27-1605272 |
| Certification: |
File details come from the government source that posted it. Updated .