A member agency of the Southern Nevada Water Authority

Las Vegas Valley Water District
1001 South Valley View Blvd.
Las Vegas, Nevada 89153
702.870.2011 or (800) 252-2011

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Vendor Information Profile

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Company Information
* Full Name of Firm or Company
*Contact Person
* Address
Address 2
* City
* State
* Zip
* Phone	( ) -
Fax:	( ) -
* E-mail
* Confirm E-mail
Company Website Address
Business License
Sales Tax ID
Organization Information
* Type of Organization (Check all that apply)		Small Business Enterprise (SBE) - Previous year's gross annual receipts did not exceed $2M for non-construction or $5M for construction.
		Physically Challenged Business Enterprise (PBE) - At least 51 percent owned and controlled by one or more disabled individuals.
		Women Owned Business Enterprise (WBE) - At least 51 percent owned and controlled by one or more non-minority women.
		Minority Owned Business Enterprise (MBE) - At least 51 percent owned and controlled by one or more individuals of African American/Black, Hispanic American, Asian-Pacific American, Asian-Indian American, or Native American heritage.
		None of the above.
Minority Information
* Minority Status	African American/Black Hispanic American Native American Asian-Pacific American Asian-Indian American None of the above
* Has your firm been certified as Small, Minority, Women-Owned, or Disadvantaged Business Enterprise?
	Yes No
If yes, Specify the Certifying Agency
Date of Certification	(mm/dd/yyyy)
Expiration Date	(mm/dd/yyyy)