Vendor_Information_Request_Form_-_fillable.pdf

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Attached to
Supply of Reverse Osmosis (RO) Membranes for the Juanita Millender-McDonald Carson Regional Water Recycling Plant
Solicitation number
IFQ-TH-0119
Issued by
Los Angeles County, California

About this file

Written by GovTribe AI ·

This Vendor Information Request Form is used by West Basin Municipal Water District to collect comprehensive vendor registration and qualification data for procurement purposes. The form requires vendors to provide complete company information, including legal name, business addresses, contact details, and vendor identification numbers. Vendors must disclose certifications such as Small Business Enterprise (SBE) and Local Business Enterprise (LBE) status, along with business license numbers and the certifying public agencies. The form mandates submission of a W-9 form and documentation proving signature authority for contract execution, such as articles of incorporation or corporate resolutions. Additionally, vendors must identify representatives authorized to receive executed agreements and those responsible for signing contracts, with all information subject to verification by West Basin.

The form also requires vendors to provide accounts receivable information including remittance names and addresses, contact information for payment-related inquiries, and confirmation of compliance with the Build America, Buy America (BABA) Act regarding domestic sourcing of product components at 65 percent or higher. Vendors must confirm standard payment terms of Net 30 days and disclose any applicable payment discounts. The form is designed to streamline vendor qualification for the RO Membranes procurement solicitation, which requires delivery within 60 calendar days from Notice of Award (by April 26, 2026) with quotations due February 26, 2026, at 2:00 p.m. through the OpenGov procurement portal. West Basin's Small and Local Business Enterprise Program provides evaluation incentives of 3 percent for SBE or LBE prime contractors and 6 percent if both designations apply, or 1 percent for prime bidders utilizing eligible subcontractors receiving at least 30 percent of total compensation. Contract award will be made to the lowest responsive bidder, with quotation validity required for 90 days from closing.

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Supply_of_Reverse_Osmosis_(RO)_Membranes_for_the_Juanita_Millender-McDonald_Carson_Regional_Water_Recycling_Plant_(Addendum_#1_Revision).pdf PDF
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Vendor_Information_Request_Form_-_fillable.pdf PDF
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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 .