Vendor_Information_Request_Form.pdf

PDF 77 KB Posted

Attached to
On-Call Professional Engineering Services State and local contract opportunity
Solicitation number
RFP-TH-0128
Issued by
Los Angeles County, California

About this file

Written by GovTribe AI ·

This is a Vendor Information Request Form utilized by West Basin Municipal Water District, a public agency serving 17 cities and approximately one million residents in the coastal Los Angeles area. The form is designed to collect comprehensive vendor information from professional engineering consulting firms seeking to provide on-call professional engineering services. The services encompass design and consulting support for the Engineering and Operations Departments on an as-needed basis, including hydraulic modeling, engineering evaluations, planning and design of water and recycled water treatment facilities, water quality studies, construction engineering services, geotechnical and environmental work, asset management support, permitting activities, cost estimations, design plan checking, surveying, and various specialized engineering disciplines including civil, structural, mechanical, and process engineering.

The form requires vendors to provide complete company information, including legal name, business addresses, contact details, vendor number, and payment terms aligned with West Basin's standard Net 30 payment policy. Vendors must demonstrate certification status as Small Business Enterprises (SBE) or Local Business Enterprises (LBE) and provide supporting documentation including W-9 forms, business licenses, and proof of signature authority for contract execution. The form also requests compliance information regarding the Build America, Buy America (BABA) Act, which requires product components to be 65 percent domestically sourced where applicable. Additionally, vendors must identify organizational representatives authorized to receive executed agreements and sign contract documents, along with relevant certification numbers from applicable public agencies.

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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
Check Box10: Off
Check Box11: Off
Check Box12: Off
Check Box13: Off
Check Box14: Off

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