36C25621R0148 EFT Form.pdf
PDF 669 KB Posted
- Solicitation number
- 36C25621R0148
About this file
This document contains a vendor file request form and details of a related federal contract opportunity for converting a laundry facility to a distribution and storage center. The vendor file request form collects company and banking information from vendors interested in doing business with the Department of Veterans Affairs. It requests details such as DUNS numbers, tax IDs, small business status, address and bank account information for electronic funds transfer.
The related federal contract opportunity is a request for proposal from the Veterans Health Administration VISN 16 to convert a laundry facility to a distribution and storage center. It provides high-level information about the type of pre-solicitation opportunity and the agency involved, but does not include pricing terms, response dates, set-asides or other contract specifics. Additional requirements are referenced in an attached document.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25621R0148 0003.docx | DOCX document | |
| RFI Register 502-17-300 23 July 2021.docx | DOCX document | |
| Equipment List.docx | DOCX document | |
| 36C25621R0148 0002.docx | DOCX document | |
| Pre-Award RFI Register 19 May 2021 Final.pdf | ||
| 36C25621R0148 0001.docx | DOCX document | |
| Sign in Sheet.pdf | ||
| 36C25621R0148 Specifications.pdf | ||
| 36C25621R0148 Drawings .pdf | ||
| 36C25621R0148 EXHIBIT F.docx | DOCX document | |
| 36C25621R0148 EXHIBIT E.docx | DOCX document | |
| 36C25621R0148 ICRA.pdf | ||
| 36C25621R0148 JA.pdf | ||
| 36C25621R0148 EXHIBIT C.docx | DOCX document | |
| 36C25621R0148 Vendor Request Form.xlsx | XLSX spreadsheet | |
| 36C25621R0148 SOW .docx | DOCX document | |
| 36C25621R0148 EXHIBIT G.docx | DOCX document | |
| 36C25621R0148 EXHIBIT A.docx | DOCX document | |
| 36C25621R0148 Solicitation.docx | DOCX document | |
| 36C25621R0148 EXHIBIT B.docx | DOCX document | |
| 36C25621R0148 EXHIBIT D.docx | DOCX document | |
| 36C25621R0148 WD.txt | TXT text file | |
| 36C25621R0148 Pre-Sol.docx | DOCX document |
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Text version
FSC VENDOR FILE REQUEST FORM
NEW UPDATE
VA FACILITY INFORMATION
STATION NUMBER
STATION CONTACT
STATION PHONE NUMBER STATION FAX NUMBER
STATION EMAIL ADDRESS
PAYEE/VENDOR TYPE (Select one)
C - COMMERCIAL
E - EMPLOYEE
I - INDIVIDUAL/HONORARIUM
V - VETERAN
F - FEDERAL AGENCY
O - FOREIGN
A - AGENT CASHIER
U - UTILITY
FACTS ID
MISCELLANEOUS ACTIONS (Select one) WINRS ASSIGNMENT (All applicable documents)
BILL OF COLLECTIONS SETTLEMENT/TORTS
ALAC/LGY ACCOUNT #
PAYEE/VENDOR INFORMATION
COMMERCIAL VENDOR REGISTERED IN SAM.GOV
(Required IAW FAR 4.1102)
DUNS NUMBER
DUNS+4
SSN/TIN
NPI
SMALL BUSINESS - VENDOR MUST BE QUALIFIED AS SMALL BUSINESS IN
SAM OR FURNISH SBA CONFIRMATION
VENDOR NAME
DBA
CONTACT
EMAIL ADDRESS
PHONE NUMBER
CURRENT ADDRESSS (Include Street, City, State and Zip Code)
PREVIOUS ADDRESSS (Include Street, City, State and Zip Code)
EFT/ACH (Required IAW 31 CFR Part 208)
BANK NAME
BANK ADDRESSS (Include City, State and Zip Code)
NINE-DIGIT BANK ROUTING NUMBER
ACCOUNT NUMBER
ACCOUNT TYPE
CHECKING SAVINGS
PAYEE/VENDOR PRINTED NAME & TITLE
SIGNATURE
NORMAL PROCESSING TIME IS 3 - 5 BUSINESS DAYS. WE DO NOT ACCEPT INVOICES
FOR QUESTIONS REGARDING THIS FORM:
NVF CONTACT INFORMATION:
NATIONWIDE VENDOR FILE CUSTOMER SERVICE:
EMAIL: VAFSCVENDOT@VA.GOV
FOR ALL OTHER INQUIRIES:
CUSTOMER CARE CENTER: 1-877-353-9791
STATION CARE CENTER: 1-866-372-1141
SUBMIT ALL DOCUMENTATION VIA:
SECURE FAX: 512-460-5221
VA FORM
APR 2014 10091
mailto:VAFSCVENDOT@VA.GOV
Bob Volck/Cassandra Wait
005/IT
10083, INFORMATION, TECHNOLOGY,
COMPUTER, ACCESS
Missie Vaccaro VA Form 10083, OFFICE OF INFORMATION TECHNOLOGY
COMPUTER ACCESS REQUEST FORM
AUGUST 2013
AUGUST 2013
\\iaimain\apps1\Pam_Ward\Logos\Formlogo.jpg Department of Veterans Affairs
FSC VENDOR FILE REQUEST FORM
F S C VENDOR FILE REQUEST FORM
VA FACILITY INFORMATION
VA FACILITY INFORMATION
STATION NUMBER
STATION CONTACT
STATION PHONE NUMBER
STATION FAX NUMBER
STATION EMAIL ADDRESS
PAYEE/VENDOR TYPE (Select one)
FACTS ID
MISCELLANEOUS ACTIONS (Select one)
PAYEE/VENDOR INFORMATION
PAYEE/VENDOR INFORMATION
DUNS NUMBER
DUNS+4
SSN/TIN
NPI
VENDOR MUST BE QUALIFIED AS SMALL BUSINESS IN
SAM OR FURNISH SBA CONFIRMATION
VENDOR NAME
DBA
CONTACT
EMAIL ADDRESS
PHONE NUMBER
CURRENT ADDRESSS (Include Street, City, State and Zip Code) PREVIOUS ADDRESSS (Include Street, City, State and Zip Code) EFT/ACH (Required IAW 31 CFR Part 208) E F T/A C H (Required I A W 31 C F R Part 208)
BANK NAME
BANK ADDRESSS (Include City, State and Zip Code)
NINE-DIGIT BANK ROUTING NUMBER
ACCOUNT NUMBER
ACCOUNT TYPE
PAYEE/VENDOR PRINTED NAME & TITLE
SIGNATURE
NORMAL PROCESSING TIME IS 3 - 5 BUSINESS DAYS. WE DO NOT ACCEPT INVOICES
NORMAL PROCESSING TIME IS 3 - 5 BUSINESS DAYS. WE DO NOT ACCEPT INVOICES
FOR QUESTIONS REGARDING THIS FORM:
NVF CONTACT INFORMATION:
NATIONWIDE VENDOR FILE CUSTOMER SERVICE:
EMAIL: VAFSCVENDOT@VA.GOV
FOR ALL OTHER INQUIRIES:
CUSTOMER CARE CENTER: 1-877-353-9791
STATION CARE CENTER: 1-866-372-1141
SUBMIT ALL DOCUMENTATION VIA:
SECURE FAX: 512-460-5221
FOR QUESTIONS REGARDING THIS FORM:
N V F CONTACT INFORMATION:
NATIONWIDE VENDOR FILE CUSTOMER SERVICE:
EMAIL: VAFSCVENDOT@VA.GOV
FOR ALL OTHER INQUIRIES:
CUSTOMER CARE CENTER: 1-8 7 7-3 5 3-97 91
STATION CARE CENTER: 1-8 6 6-3 7 2-11 41
SUBMIT ALL DOCUMENTATION VIA:
SECURE FAX: 5 1 2-4 6 0-52 21
VA FORM
APR 2014
V A FORM 1 0 0 9 1, APRIL 2014
10091
| "UPDATE" CHECKBOX: 0 |
| "UPDATE" CHECKBOX: 0 |
| STATION NUMBER: |
| SIGNATURE: |
| ACCOUNT NUMBER LINE 2 OF 2: |
| ACCOUNT TYPE: "SAVINGS" CHECKBOX: 0 |
| ACCOUNT TYPE: "SAVINGS" CHECKBOX: 0 |
| ACCOUNT TYPE: "SAVINGS" CHECKBOX: 0 |
| COMMERCIAL VENDOR REGISTERED IN SAM.GOV (Required IAW FAR 4.1102) CHECKBOX: 0 |
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