Vendor_Information_Request_Form_.pdf
PDF 80 KB Posted
- Attached to
- Investment Management Services
- Solicitation number
- RFP-TH-0121
- Issued by
- Los Angeles County, California
About this file
This is a Vendor Information Request Form for West Basin Municipal Water District in California related to a solicitation for Investment Management Services. The form is designed to collect comprehensive vendor information from prospective contractors, including company details, certification status, contact information, and authorization documentation. Vendors must provide their complete legal name, business address, contact phone and fax numbers, and email addresses. The form requires vendors to identify representatives who will receive executed agreements and those authorized to sign contracts, along with supporting documentation proving signature authority such as Articles of Incorporation or corporate resolutions. Additionally, vendors must disclose their certification status as Small Business Enterprises (SBE) or Local Business Enterprises (LBE), along with corresponding certification and business license numbers and documentation.
The form establishes West Basin's standard payment terms as Net 30 days and requests information regarding payment discounts. Vendors are also required to authorize West Basin to verify the information provided on the form and must disclose whether their products comply with the Build America, Buy America (BABA) Act requirements, which mandate that product components be 65% domestically sourced. The form includes sections for accounts receivable remittance information and allows for multiple contact representatives and addresses to be listed. The document was dated January 22, 2026, and serves as the administrative intake mechanism for vendors seeking to conduct business with West Basin Municipal Water District.
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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: |
| Group5: Off |
| Check Box8: Off |
File details come from the government source that posted it. Updated .