FMS Vendor File Update Request.pdf
PDF 496 KB Posted
- Attached to
- M1LZ--VASDHS OFF-SITE EMPLOYEE PARKING SERVICES
- Solicitation number
- 36C26225R0066_1
About this file
This document is a Vendor Information Form for YHB Long Beach LLC, associated with Solicitation 36C26225Q0125 from the Department of Veterans Affairs. The form captures key vendor details including business contact information, physical address (4353 E Willow St, Long Beach, CA 90815), point of contact (CJ Lillis), phone number (562-588-9611), and email (clillis@yhbhospitality.com).
The vendor has a Unique Entity ID of MLW6LKG9H827 and CAGE Code 30GW8. The form indicates the vendor is registered for federal contracting, with sections confirming Central Contractor Registration (CCR) status and requiring checks against exclusion databases. The vendor is classified as a small business and has indicated acceptance of purchase cards. Additional socioeconomic classifications are left unselected, and the vendor does not currently have an existing contract with the agency.
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Other files
| File | Type | Posted |
|---|---|---|
| VA10091.pdf | ||
| FMS Vendor File Update Request Form.pdf | ||
| W-9 Form.pdf | ||
| W-9 Form.pdf | ||
| 36C26225R0066_1.docx | DOCX document | |
| D.3 VENDORIZATION FORMS.docx | DOCX document | |
| D.2 WAGE DETERMINATION.docx | DOCX document | |
| VAAR 852.219-75 .docx | DOCX document | |
| D.1 SOW.docx | DOCX document | |
| SOLICITATION-DESCRIPTION.docx | DOCX document | |
| VA10091.pdf |
Show all 11
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Text version
VENDOR INFORMATION
1. REQUESTOR:
2. SERVICE:
3. EXTENSION:
4. VENDOR NAME:
Doing Business As/Legal Name:
5. VENDOR ADDRESS
Physical Location:
Mailing Address:
City:
State/Zip:
6. VENDOR TAX IDENTIFICATION NO. or
SOCIAL SECURITY NUMBER:
(Mandatory field must enter one or the other)
TIN:
SSN:
7. VENDOR PHONE & FAX NUMBER:
Phone:
Fax:
Email: :
8. PAYMENT STREET ADDRESS:
Address:
City:
State/Zip:
9. POINT OF CONTACT:
10. ACCOUNT NUMBER:
11. Does Vendor have an existing contract? YES NO If answer is YES, please enter Contract Number:
(i.e. GS-, V797 or any other contract with payment terms N/30 and expiration date) Beginning Date: Expiration Date:
FOB: Destination Origin Prompt Payment Discount: _________ (i.e. 2%/10; 1%/20 or N/30)
12. 1099 Vendor Indicator: YES (Always YES except if FEDERAL Government) NO
13. Business Type (FPDS) (Must check one): Small Large Outside VA Other Entities
14. Socioeconomic Group: (Please check all that apply) Sm Disadvantage Bus Javits-Wagner-O’Day Hubzone Small Business Veteran-Owned Small Bus Woman-Owned Small Business Historically Black College & Univ./Min Institute Veteran-Owned Large Bus Woman-Owned Large Business None of the other business Veteran-Service Disabled
15. Purchase Card Accepted YES NO
16. DUN and BRADSTREET NUMBER: ___________________________ (Mandatory-if vendor does not have one they need to go to http://www.dnb.com to register.
17. Is Vendor registered with Central Contractor Registration (CCR)? YES NO (Mandatory-if vendor is not registered they can accomplish the task at: http://www.ccr.gov to register.
18. Before we may enter any new vendor information within the VA database the mandatory registration sites shall be checked along with the status of the vendor’s ability to do business within the Federal Government. Failure to check the mandatory field(s) could result in administrative action. The following two sites are your final check .
http://epls.arnet.gov/ & http://exclusions.oig.hhs.gov/
Department of Veterans Affairs Re: Solicitation 36C26225Q0125
714-408-5435 clillis@yhbhospitality.com
562-588-9611
CJ Lillis
N/A
4353 E WILLOW St Long Beach, CA 90815
Unique Entity ID: MLW6LKG9H827
Cage Code: 30GW8
YHB LONG BEACH LLC
File details come from the government source that posted it. Updated .