Vendor_Information_Request_Form_-_fillable.pdf

PDF 67 KB Posted

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 a fillable document used by the West Basin Municipal Water District to collect standardized vendor information for procurement purposes related to the supply of 852 reverse osmosis (RO) membrane elements (8 x 40 inches) for the Juanita Millender-McDonald Carson Regional Water Recycling Plant in El Segundo, California. The procurement includes 792 membrane elements for initial installation and 60 as spares, along with associated spare parts and equipment compatible with Advanced Structures Codeline Model 80A45 6-element pressure vessels. Qualified bidders must deliver all materials within 60 consecutive calendar days from the Notice of Award or by April 26, 2026, whichever is earlier, with the deadline for questions set at February 16, 2026, at 2:00 p.m. and quotations due on February 26, 2026, at 2:00 p.m., submitted electronically through the OpenGov procurement system. The supplier must provide on-site representation during membrane installation, complete technical documentation including shop drawings and factory testing reports, and system performance warranty coverage for three years from the start of System Performance Testing.

The form requires vendors to provide complete company information, accounts receivable details, W-9 documentation, proof of Small Business Enterprise (SBE) or Local Business Enterprise (LBE) certification if applicable, signature authority documentation, and confirmation of compliance with the Build America, Buy America (BABA) Act requiring 65% domestically sourced product components. Standard payment terms are Net 30 days with invoicing directed to invoices@westbasin.org. West Basin's Small and Local Business Enterprise Program offers evaluation incentives including a 3% reduction for SBEs or LBEs proposing as prime contractors, or 6% if both designations apply, and a 1% reduction for prime bidders utilizing SBE or LBE subcontractors receiving at least 30% of total compensation. Bidders must submit separate pricing for membrane elements, spare parts per Exhibit A, applicable sales tax of 9.75%, and freight costs delivered to the Edward C. Little Water Recycling Facility. Vendors must maintain comprehensive insurance coverage including $2,000,000 commercial general liability, $1,000,000 automobile liability, workers' compensation insurance, and $1,000,000 pollution liability insurance, and must comply with California Prevailing Wage Laws for applicable public works projects exceeding $1,000 in total compensation. Contract award will be made to the responsive bidder with the lowest total cost, and quotation validity must be maintained for at least 90 days from the closing date.

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Other files

File Type Posted
Supply_of_Reverse_Osmosis_(RO)_Membranes_for_the_Juanita_Millender-McDonald_Carson_Regional_Water_Recycling_Plant_(Addendum_#1_Revision).pdf PDF
Supply_of_Reverse_Osmosis_(RO)_Membranes_for_the_Juanita_Millender-McDonald_Carson_Regional_Water_Recycling_Plant.pdf PDF
WB_JMMCRWRP_Scope_of_Supply_RO_Membranes.pdf PDF
Vendor_Information_Request_Form_-_fillable.pdf PDF
Purchase_Order_Template-Goods-No_LC-(2023).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:

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