Vendor_Information_Request_Form.pdf

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Attached to
Torrance Refinery Water Recycling Plant Microfiltration Feasibility Study
Solicitation number
RFP-TH-0117
Issued by
Los Angeles County, California

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Vendor Information Request Form Summary

This document is a Vendor Information Request Form issued by West Basin Municipal Water District, a Los Angeles County, California water agency. The form serves as the initial registration and qualification documentation required for vendors seeking to conduct business with West Basin. The form requests comprehensive company information including legal business name, contact details, addresses, and vendor identification numbers. A pre-proposal meeting is scheduled for February 17, 2026, with questions and clarifications due by February 19, 2026, and proposal submissions required electronically by 2:00 PM on February 26, 2026. Contract award notification is expected by March 9, 2026. The specific engagement involves professional engineering services for a feasibility study of the Microfiltration System Replacement at the Torrance Refinery Water Recycling Plant, with the consultant required to evaluate a minimum of five alternatives and deliver comprehensive feasibility analysis, preliminary design criteria, environmental assessments, regulatory compliance review, Class 4 cost estimates, and life cycle cost comparisons across multiple submission stages (draft, draft final, and final).

Vendors must demonstrate certification as Small Business Enterprises (SBE) and/or Local Business Enterprises (LBE) where applicable, with documentation of business licenses and certification numbers required. West Basin's Small and Local Business Enterprise program offers evaluation incentives including three additional points for SBE or LBE prime consultants (six points if both apply) or one point for SBE/LBE subcontractors receiving at least 30 percent of total contract compensation, with price proposals reduced by 3 percent (or 6 percent for dual certification) during evaluation. Required insurance coverage includes Commercial General Liability of $2,000,000 per occurrence, Business Automobile Liability of $2,000,000 per accident, Workers' Compensation with $1,000,000 Employer's Liability per accident, and Professional Liability of $2,000,000 per occurrence. Compensation will be structured on a time-and-material basis with monthly invoices submitted in arrears and payment issued within Net 30 days of receipt. No specific budget or award value is provided in the RFP documents, and no incumbent vendor has been identified for this new feasibility study engagement.

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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:
Yes:
No:
Same:
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:
Yes 3:
No 3:
Yes 4:
No 4:
Print Name 1:
Yes 1:
No 1:
Yes 2:
No 2:
Date1_af_date:

File details come from the government source that posted it. Updated .