Vendor_Information_Request_Form.pdf
PDF 77 KB Posted
- Solicitation number
- RFB-TH-0145
- Issued by
- Los Angeles County, California
About this file
This is a Vendor Information Request Form issued by West Basin Municipal Water District in California for the Donald L. Dear Building Elevator Modernization Project. The form serves as the primary registration and qualification document for vendors seeking to bid on or contract with West Basin. The document requests comprehensive company information including legal business name, addresses, contact details, and vendor identification numbers. Key sections address certification status, specifically Small Business Enterprise (SBE) and Local Business Enterprise (LBE) designations, along with requirements to submit supporting documentation such as business licenses and certification verification. The form also requires vendors to identify authorized representatives responsible for executing agreements, with submission of proof of signature authority such as Articles of Incorporation or corporate resolutions. Additionally, the form inquires about compliance with the Build America, Buy America (BABA) Act, requiring that product components be 65% domestically sourced where applicable.
The form establishes West Basin's standard payment terms as Net 30 days and requests information regarding any available payment discounts. Vendors must authorize West Basin to verify the information provided on the form through their signature. The document includes multiple sections for accounts receivable information, including remittance names and addresses, and allows for designation of multiple organizational representatives to receive copies of executed agreements. The form was dated January 22, 2026, and contains numerous blank fields and checkboxes designed to capture complete vendor qualification data necessary for procurement processing and vendor management purposes.
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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 .