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EXHIBIT H <br /> COUNTY OF ALAMEDA <br /> RFP No. 900973 <br /> for <br /> Operation and Maintenance Services of Sewer and Water Systems in the Alameda County Service <br /> Area (CSA) R-1967-1 Castlewood <br /> ALAMEDA COUNTY VENDOR FIRST SOURCE AGREEMENT <br /> VENDOR INFORMATION <br /> ALCOLINK Vendor Number(if known): 00000 SLEB Vendor Number: <br /> Full Legal Name: <br /> DBA <br /> Type of Entity: ❑ Individual ❑ Sole Proprietor ❑ Partnership <br /> ❑ Corporation❑ Tax-Exempted ❑ Government or Trust <br /> Check the boxes that apply: <br /> ❑ Goods Only ❑ Goods & Services ❑ Rents/Leases ❑ Legal Services <br /> ❑ Rents/Leases paid to you as the agent ❑ Medical Services ❑ Non-Medical Services —Describe <br /> ❑ Other <br /> Federal Tax ID Number(required): <br /> P.O. Box/Street Address: <br /> Vendor Contact's Name: <br /> Vendor Contact's Telephone: Fax: <br /> Vendor Contact's E-mail address: <br /> Please check all that apply: <br /> LOC ❑ Local Vendor(Holds business license within Alameda County) <br /> SML ❑ Small Business (as defined by Small Business Administration) <br /> I American Indian or Alaskan Native (>50%) <br /> A ❑ Asian (>50%) <br /> B Black or African American (>50%) <br /> F Filipino (>50%) <br /> H ❑ Hispanic or Latino (>50%) <br /> N Native Hawaiian or other Pacific Islander(>50%) <br /> W White(>50%) <br /> Number of entry level positions available through the life of the contract: <br /> Number of other positions available through the life of the contact: <br /> 'Phis information to he completed by County: <br /> Contract# <br /> Contract Amount: <br /> Contract Term: <br /> Revision 10-22-09 <br />