Vendor_Information_Request_Form_.pdf

77 KB Posted

Attached to
Water Use Efficiency Framework Support
Solicitation number
RFP-DS-0150
Issued by
Los Angeles County, California

About this file

Written by GovTribe AI ·

This is a Vendor Information Request Form submitted to West Basin Municipal Water District, a California-based municipal water agency, in connection with a Water Use Efficiency Framework Support contract opportunity. The form serves as the initial vendor registration and qualification document for West Basin's procurement process, collecting comprehensive company information, certification status, and authorized representatives for contract execution. The form requests completion of standard vendor details including legal business name, address, contact information, and vendor number assignment. Vendors are required to identify authorized signatories with proof of signature authority and designate representatives to receive executed agreements. The form indicates West Basin's standard payment terms are Net 30 days. The underlying contract opportunity involves West Basin seeking consultant support to assist participating retail agencies within its service area with compliance with California's "Making Conservation a California Way of Life" regulations, with West Basin serving as the Lead Agency administering the contract on behalf of these participating agencies.

The form requires vendors to submit documentation of Small Business Enterprise (SBE) and Local Business Enterprise (LBE) certifications if applicable, along with business licenses and relevant certification numbers from public agencies. Vendors must also confirm compliance with the Build America, Buy America (BABA) Act regarding domestic sourcing requirements for product components at 65 percent or higher. The form date of 1-22-2026 indicates this is a current or recently issued request, and West Basin authorizes verification of all submitted information upon vendor signature. No specific pricing, award amounts, or contract term details are provided within this vendor information form itself, as it functions as a preliminary qualification and registration document rather than a complete bid package or solicitation notice.

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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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