Vendor_Information_Request_Form.pdf

67 KB Posted

Attached to
Torrance Refinery Water Recycling Plant Microfiltration Feasibility Study
Solicitation number
RFP-TH-0117
Issued by
Los Angeles County, California

About this file

Written by GovTribe AI ·

This is a Vendor Information Request Form from West Basin Municipal Water District used to collect vendor registration and qualification data for contract opportunities. The form gathers comprehensive company information including legal business name, addresses, contact details, and vendor identification numbers. It requests documentation of signature authority for contract execution, such as articles of incorporation or corporate resolutions, and identifies organizational representatives authorized to receive executed agreements and sign contracts on behalf of the vendor.

The form requires vendors to disclose certifications as Small Business Enterprises (SBE) or Local Business Enterprises (LBE), with supporting documentation mandated for each certification type. It collects accounts receivable and remittance information, payment terms (with West Basin standard terms of Net 30 days), and requests confirmation of compliance with the Build America, Buy America (BABA) Act requiring 65 percent domestically sourced product components. The form authorizes West Basin to verify all stated information through vendor signature and includes multiple fields for additional representatives, contact information, and alternative addresses, allowing flexibility for vendors with multiple locations or organizational contacts.

View the file

Other files

File Type Posted
Torrance_Refinery_Water_Recycling_Plant_Microfiltration_Feasibility_Study.pdf PDF
Mobil_CMF_O&M_Manual_Overview_(1).pdf PDF
TRWRP_MF_SOP.pdf PDF
Scope_of_Work.pdf PDF
Sample_Agreement_-_Form_4_-_Non-Pro_Consultant.docx DOCX document
Sample_Agreement_-_Form_7_-_General_Services.docx DOCX document
Form_3_-_Pro-Svc_Non-Tech_-_102618.docx DOCX document
Sample_Agreement_-_Form_9_-_Supply.docx DOCX document
Sample_Agreement_-_Form_8_-_Transportation_Services.docx DOCX document
Sample_Agreement_-_Form_5_-_On-Call_Engineering_Service.docx DOCX document
Form_1_-_Engineering_Service_-_102618.docx DOCX document
Show all 11

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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:
Yes:
No:
Same:
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:
Yes 3:
No 3:
Yes 4:
No 4:
Print Name 1:
Yes 1:
No 1:
Yes 2:
No 2:
Date1_af_date:

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