Vendor_Information_Request_Form_.pdf

77 KB Posted

Attached to
On Campus Water Education Assemblies for 2026-2027
Solicitation number
RFP-DS-0148
Issued by
Los Angeles County, California

About this file

Written by GovTribe AI ·

This is a Vendor Information Request Form from West Basin Municipal Water District in California, used to collect essential vendor and company information for procurement purposes. The form requests detailed company information including legal name, business address, contact details, and vendor number. The related contract opportunity is for On Campus Water Education Assemblies for the 2026-2027 school year, requiring the selected respondent to plan and implement water conservation-focused assembly programs for schools within West Basin's service area. The programs must educate participants about California water resources, water conservation importance, and water stewardship through high-quality, hands-on educational content. Up to 24 sessions will be offered annually, and West Basin is seeking to award a one-year contract to an ideal respondent with demonstrated capability to deliver consistently high-quality programming led by highly trained instructors.

The vendor information form requires submission of a W-9, proof of signature authority for contract execution, and documentation of any Small Business Enterprise (SBE) or Local Business Enterprise (LBE) certifications if applicable. Cost proposals must incorporate project administration, participation data collection, reporting, planning, employee benefits and salary, travel time, and vehicle and fuel costs. West Basin offers standard payment terms of Net 30 days. The form also requests vendor confirmation regarding compliance with the Build America, Buy America (BABA) Act, which requires 65 percent domestic sourcing of product components. Vendors must authorize West Basin to verify all information provided on the form and identify representatives responsible for receiving executed agreements and signing contracts.

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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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