Vendor_Information_Request_Form.pdf
PDF 77 KB Posted
- Attached to
- Torrance Refinery Water Recycling Plant Sulfuric Acid Day Tank Area Rehabilitation and Replacement Project
- Solicitation number
- RFB-TH-0140
- Issued by
- Los Angeles County, California
About this file
This is a Vendor Information Request Form issued by West Basin Municipal Water District for the Torrance Refinery Water Recycling Plant Sulfuric Acid Day Tank Area Rehabilitation and Replacement Project in California. The form collects comprehensive vendor information required for participation in the bidding process, including company legal name, address, contact information, and authorization to verify submitted information. Vendors must identify representatives authorized to sign agreements and provide documentation proving signature authority, such as Articles of Incorporation or corporate resolutions. The form requires vendors to list multiple contacts across purchasing and accounts receivable functions, as well as representatives who will receive executed agreements upon contract award.
The form addresses vendor certifications and compliance requirements, including Small Business Enterprise (SBE) and Local Business Enterprise (LBE) status, with corresponding documentation submission requirements. Payment terms are established at Net 30 days. Vendors must indicate compliance with the Build America, Buy America (BABA) Act if applicable, requiring that product components be 65% domestically sourced. The form is dated January 22, 2026, and serves as the primary mechanism for West Basin Municipal Water District to collect vendor qualification and contact information prior to contract execution, ensuring all necessary parties are identified and authorized before project work commences.
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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 |
| Check Box10: Off |
| Check Box11: Off |
| Check Box12: Off |
| Check Box13: Off |
| Check Box14: Off |
File details come from the government source that posted it. Updated .