Vendor_Information_Request_Form_.pdf
PDF 80 KB Posted
- Solicitation number
- IFQ-TH-0122
- Issued by
- Los Angeles County, California
About this file
This is a Vendor Information Request Form issued by West Basin Municipal Water District, a public agency serving 17 cities and nearly one million residents in coastal Los Angeles. West Basin is soliciting quotations for the supply and delivery of three (3) ChargePoint model CT4021-GW1 Level 2 commercial electric vehicle charging stations to be installed at the Edward C. Little Water Recycling Facility in El Segundo, California. Each unit must include dual-port capability, bollard concrete mounting kits, activation fees, and comply with specified technical standards including SAE J1772 connectors, cloud-based LTE operation, UL certifications, NEC Article 625, and Energy Star standards. The chargers must deliver 30-ampere power output with 7.2 kW per port capability and operate across temperature ranges of -40°C to 50°C. Quotations are due electronically through the procurement portal by April 23, 2026 at 2:00 pm, with a deadline for submitting questions by April 16, 2026 at 4:00 pm. All quotations must remain valid for at least 90 days from the closing date. The award will be made to the lowest responsive quotation, subject to Board of Directors approval.
Required line items include the three charging stations, three mounting kits, and three activation fees, subject to 9.5% sales tax, with optional prepaid three-year commercial cloud plans and maintenance available. Payment terms are net 30 days from receipt of correctly completed invoices, with goods shipped prepaid F.O.B. destination. West Basin encourages participation from Small Business Enterprises (SBEs) and Local Business Enterprises (LBEs), offering evaluation scoring adjustments of 3% for SBEs or LBEs as prime contractors, 6% for bidders qualifying as both, and 1% for prime contractors utilizing qualified SBE or LBE subcontractors receiving at least 30% of contract compensation. Qualified bidders must submit vendor information including business registration, certifications, proof of signature authority, and compliance with Build America, Buy America Act requirements mandating 65% domestically sourced components. New vendors must submit a W-9 form, and all bidders must provide proof of business licenses and relevant public agency certifications. Vendors must maintain comprehensive insurance coverage including $2,000,000 general liability and $1,000,000 pollution liability, provide full indemnification, and comply with prevailing wage requirements if applicable.
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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: |
| Group5: Off |
| Check Box8: Off |
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