Requestor's Information Name * Phone Number * Email Address * Vendor Status * New Vendor Application Established Vendor Update What is being updated? Vendor Information Name * Website Phone Number Mailing Address Street or P.O. Box * City * State * Zip Code * Goods and Services Provided Good Service or Both * Please choose one of the following Goods Services Goods and Services Products and Services Provided * Please choose the most appropriate department - Select -EngineeringHeavy EquipmentWater Production Products and ServicesInformation TechnologySafety Products and ServicesAdministrative/Office Products and ServicesProject ManagementInstrumentation & Electronics Referred by a GCWA Employee? * Yes No GCWA Employee Name Please provide GCWA Employee Name Is the request related to a GCWA Project? * Yes No Project Name * Please provide Project Name Required Vendor Documents Taxpayer Identification and Certification (W-9) Taxpayer Identification and Certification (W-9) * Files must be less than 100 MB.Allowed file types: gif jpg jpeg png pdf. An incomplete Taxpayer Identification and Certification (W-9) form may delay or void a New Vendor Request. Conflict of Interest (CIQ) Does vendor have a business relationship with a GCWA employee or a member of the GCWA Board of Directors? * Yes No Vendor's who have a business relationship with a member of the GCWA Board of Directors, please complete all sections of the CIQ Form, Sign, and Date. Vendors who do not have a business relationship with a member of the GCWA Board of Directors, please complete the following sections of the CIQ, Sign, and Date.1. Vendor's Name3. None (Indicating no Business Relationship) Conflict of Interest (CIQ) * Files must be less than 100 MB.Allowed file types: gif jpg jpeg png pdf. An incomplete Conflict of Interest (CIQ) form may delay or void a New Vendor Request. Insurance Insurance Files must be less than 100 MB.Allowed file types: gif jpg jpeg png pdf. Please see the GCWA Policy and Procedures for Procurement of Goods and Services for more information on Insurance Requirements. Comments Leave this field blank
