Vendor_Questionaire_(Form_AA-1).pdf
PDF 255 KB Posted
- Attached to
- Toy Filled Plastic Eggs - Egg Bowl Event
- Solicitation number
- 2023-Informal-169
- Issued by
- Los Angeles County, California
About this file
The document is a Vendor Questionnaire (Form AA-1) from the Purchasing & Payables Division of the City of Pasadena, California, located at 100 N. Garfield Ave., Room 328, Pasadena, CA 91101. The form is an Affidavit of Equal Opportunity Employment & Non-segregation, which requires vendors to declare under penalty of perjury that they adhere to equal opportunity employment practices and do not maintain segregated facilities.
The questionnaire requests vendors to provide their company information, including name, contact details, business license number, and a description of goods and services they would provide. For public works contracts, vendors must include their Department of Industrial Relations Registration Number. The form also offers an optional section for statistical reporting, allowing vendors to self-identify ownership characteristics such as African-American, Asian, Armenian, Hispanic, Native American, Disabled, or Female. The document is specifically relevant to potential contractors for city contracts, emphasizing non-discrimination and equal opportunity employment practices.
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Text version
Purchasing & Payables Division 100 N. Garfield Ave., Room 328 Pasadena, CA 91101
(626) 744-6755
(626) 744-6757 Fax Internet: www.cityofpasadena.net/purchasing
Vendor Questionnaire (Form AA-1) Affidavit of Equal Opportunity Employment & Non-segregation
By submitting this form you are declaring under penalty of perjury under the laws of the State of California and the laws of the United States that the information is true and correct. Furthermore, you are certifying that your firm will adhere to equal opportunity employment practices to assure that applicants and employees are not discriminated against because of their race, religion, color, national origin, ancestry, disability, sex or age. And, your firm does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not and will not permit its employees to perform their services at any location, under its control, where segregated facilities are maintained.
Name of Company Telephone
Address Fax Number (optional)
City State Zip
Contact Person E-mail Address
DBA (if applicable)
Active City of Pasadena Business License Number
Remit Address (if different)
Please state clearly and concisely the type(s) of goods and services your company would provide on this contract:
Required For All Public Works: Pursuant to Division 2, Part 7, Chapter 1 (commencing with section 1720) of the California Labor Code, you must provide your Registration Number under the Department of Industrial Relations:
Small and Micro Business Preference Program: If certified by California Department of General Services as a small or micro business, please provide DGS Reference Number:
(Visit the Purchasing Division website for additional information)
The following section is OPTIONAL and is for statistical reporting purposes only. Ownership (please check all that apply):
African- American Asian Armenian Hispanic
Native American Disabled Female
Revised 12/10/15 http://www.cityofpasadena.net/purchasing
| Name of Company: |
| Telephone: |
| Address: |
| Fax Number: |
| City: |
| State: |
| Zip: |
| Contact Person: |
| Email Address: |
| DBA if applicable: |
| Active City of Pasadena Business License Number: |
| Remit Address if different: |
| Please state clearly and concisely the types of goods and services your company would provide on this contract 1: |
| Please state clearly and concisely the types of goods and services your company would provide on this contract 2: |
| Required For All Public Works Pursuant to Division 2 Part 7 Chapter 1 commencing with section 1720 of the California Labor Code you must provide your Registration Number under the Department of Industrial Relations: |
| Small and Micro Business Preference Program If certified by California Department of General Services as a small or micro business please provide DGS Reference Number Visit the Purchasing Division website for additional information: |
| American: |
| Asian: |
| Armenian: |
| Hispanic: |
| American_2: |
| Disabled: |
| Female: |
File details come from the government source that posted it. Updated .