Vendor_Information_Request_Form_.pdf
PDF 77 KB Posted
- Solicitation number
- RFP-GR-0130
- Issued by
- Los Angeles County, California
About this file
This is a Vendor Information Request Form from West Basin Municipal Water District in California, used to establish vendor eligibility and collect necessary documentation for contract participation. The form requires vendors to provide comprehensive company information including legal name, contact details, and business addresses, along with documentation of signature authority for contract execution. West Basin seeks instructor services for education programs at the Edward C. Little Water Recycling Facility, requiring vendors to provide staff for school tours (3-4 times weekly during September-June school year with up to two staff members per session), ad hoc public tours (maximum 24 annually with up to two staff members per session), and art lessons (maximum 24 sessions during January-March). Respondents must have sufficient staffing capacity to cover all scheduled sessions and deliver high-quality educational programs featuring specialized water education content and innovative, hands-on pedagogy aligned with West Basin's commitment to water conservation education.
Vendor proposals must incorporate comprehensive cost projections including project administration, participation data collection and reporting, staff planning, employee benefits and salaries, travel time, vehicle costs, and fuel expenses. The form requires verification of Small Business Enterprise (SBE) and Local Business Enterprise (LBE) certification status, with submission of relevant certification documentation and business licenses. West Basin's standard payment terms are Net 30 days. Vendors must complete the information request form, provide W-9 documentation, authorize background verification, and confirm compliance with the Build America, Buy America (BABA) Act if applicable, with product components required to be 65 percent domestically sourced. The form includes fields for designating representatives authorized to receive executed agreements and sign contracts, requiring supporting documentation of signature authority such as articles of incorporation or corporate resolutions.
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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: |
| Check Box8: Off |
| Check Box4: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Check Box9: Off |
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| Check Box14: Off |
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