Vendor_Information_Request_Form.pdf

77 KB Posted

Attached to
JMMCRWRP Sodium Hypochlorite Tank Replacement Project
Solicitation number
RFB-TH-0134
Issued by
Los Angeles County, California

About this file

Written by GovTribe AI ·

This is a Vendor Information Request Form used by West Basin Municipal Water District in California for vendor registration and qualification purposes related to the JMMCRWRP Sodium Hypochlorite Tank Replacement Project. The project involves removing and replacing an existing sodium hypochlorite storage tank, foundation, and appurtenances, along with installing a temporary bypass system to maintain plant operations during construction. The work must be completed within 410 calendar days. The form captures essential vendor information including company legal name, contact details, business addresses, and designated representatives for contract execution and agreement receipt.

The form requires vendors to provide certification documentation for Small Business Enterprise (SBE) and Local Business Enterprise (LBE) status, along with proof of signature authority for contract representatives. West Basin operates on standard Net 30 payment terms. Vendors must also confirm compliance with the Build America, Buy America (BABA) Act requiring 65% domestically sourced product components if applicable. The form authorizes West Basin to verify all submitted information and requires vendor signatures as authorization for verification. This document serves as the initial qualification step for vendors seeking to participate in the sodium hypochlorite tank replacement project bid process.

View the file

Other files

File Type Posted
Attachment_A_-_WBMWD_JMM_SHC_Tank_Replacement_RFB_&_Specs_062926.pdf PDF
Attachment_B_-_WBMWD_JMM_SHC_Tank_Replacement_Plans_062926.pdf PDF

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:
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 .