Vendor_Information_Request_Form-fillable.pdf
PDF 113 KB Posted
- Solicitation number
- RFP-TH-0115
- Issued by
- Los Angeles County, California
About this file
This is a Vendor Information Request Form for West Basin Municipal Water District, a California municipal water agency seeking to establish vendor relationships for procurement purposes. The form is used to collect essential vendor data including complete legal company name, Federal Tax ID, W-9 information, and designated remittance addresses for payment processing. West Basin follows Net 30 payment terms and offers standard payment discount options. The form also captures vendor contact information across multiple departments, including primary contacts, accounts receivable personnel, and purchase order recipients, along with documentation of how long the vendor has maintained its current business address.
The form includes sections for vendors to self-certify their Small Business Enterprise (SBE) status with specific public agencies and provide associated certification numbers. This information is critical given West Basin's evaluation criteria for the Commercial Real Estate Brokerage Tenant Representation & Consulting Services solicitation, which awards additional evaluation points to SBE and Local Business Enterprise (LBE) certified firms—up to six points for firms holding both designations. The vendor form serves as the foundational documentation required before West Basin processes vendor requests, with authorization for the district to verify all stated information. Vendors must provide a completed W-9 form and identify their tax classification to enable proper payment processing and regulatory compliance.
View the file
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| File | Type | Posted |
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| Commercial_Real_Estate_Brokerage_Tenant_Representation_&_Consulting_Services.pdf | ||
| Vendor_Information_Request_Form-fillable.pdf | ||
| Exhibit_A_-_RE_Services_FYE_2026_ERO_WO_(12172025).pdf | ||
| Sample_Agreement_-_Form_4_-_Non-Pro_Consultant.docx | DOCX document | |
| Sample_Agreement_-_Form_8_-_Transportation_Services.docx | DOCX document | |
| Sample_Agreement_-_Form_5_-_On-Call_Engineering_Service.docx | DOCX document | |
| Sample_Agreement_-_Form_7_-_General_Services.docx | DOCX document | |
| Form_1_-_Engineering_Service_-_102618.docx | DOCX document | |
| Form_3_-_Pro-Svc_Non-Tech_-_102618.docx | DOCX document | |
| Sample_Agreement_-_Form_9_-_Supply.docx | DOCX document |
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Text version
Entered By:
City/State/Zip:
Contact Email:
Tax Classification:
Contact Phone:
Contact Name:
How long at this address? Contact Email:
Payment Discounts:
(West Basin terms are Net 30)
Contact Fax:
Contact Email:
Which Public Agency are you Certified With :
Certification Number:
Print Name:
Contact Phone:
Certification Number:
City/State/Zip:
Address 2:
City/State/Zip:
Are you a Certified Small Business Enterprise? If yes, please provide the following information:
Address 1:
W-9 Received:
Which Public Agency are you Certified With :
Contact Fax:
COMPANY INFORMATION
Contact Name:
Contact Fax:
Address 1:
Address 1: Contact Phone:
Address 2:
Remittance name:
VENDOR INFORMATION REQUEST - West Basin Municipal Water District
Requested By: Request Date: Request:
Complete Legal Name:
Address 2:
PURCHASE ORDER ADDRESS (WHERE PURCHASE ORDER IS SENT)
Signature:
Federal Tax ID #:
W-9 INFORMATION
By signing, you authorize West Basin to verify the information stated on this form.
Title:
Box 1:
Date:
ACCOUNTS RECEIVABLE (REMITTANCE NAME AND ADDRESS)
VENDOR SMALL BUSINESS ENTERPRISE INFORMATION
Vendor Number:
FOR PURCHASING ONLY
Which Public Agency are you Certified With :
Certification Number:
Yes No
New
NoYes
ChangeNew
Sheet1
| Complete Legal Name: |
| Address 1: |
| Contact Phone: |
| Address 2: |
| Contact Fax: |
| CityStateZip: |
| How long at this address: |
| Contact Email: |
| Title: |
| Print Name: |
| Federal Tax ID: |
| Remittance name: |
| Contact Name: |
| Address 1_2: |
| Contact Phone_2: |
| Address 2_2: |
| Contact Fax_2: |
| CityStateZip_2: |
| Contact Email_2: |
| Address 1_3: |
| Contact Name_2: |
| Address 2_3: |
| Contact Phone_3: |
| CityStateZip_3: |
| Contact Fax_3: |
| Contact Email_3: |
| Which Public Agency are you Certified With: |
| Certification Number: |
| Which Public Agency are you Certified With_2: |
| Certification Number_2: |
| Which Public Agency are you Certified With_3: |
| Certification Number_3: |
| Entered By: |
| Vendor Number: |
| Box_1: [N/A] |
| Tax Classification: [Individual/Sole Proprietor] |
| Payment Discounts: [1%10 - 1% 10 DAYS; NET 30 DAYS] |
| Small Business_Yes: Off |
| Small Business_No: Off |
| W9 Received_Yes: Off |
| W9 Received_No: Off |
| Request_New: Off |
| Request_Change: Off |
| Request Date: |
| Date Entered: |
| Requested By: |
File details come from the government source that posted it. Updated .