FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Attached to
- V212--PVAMC Shuttle Services Federal contract opportunity
- Solicitation number
- 36C26226Q0004
About this file
The document is a Vendor Information form used by the Department of Veterans Affairs (VA) to collect comprehensive vendor details for potential contract registration. The form requires vendors to provide key information including business name, contact details, tax identification, business type, socioeconomic status, and registration verification through mandatory sites like Central Contractor Registration (CCR) and Dun & Bradstreet.
Specific required fields include vendor physical and mailing addresses, phone/fax/email contact information, tax identification number, existing contract details, business classification (small/large, socioeconomic group), purchase card acceptance, and verification of registration status on federal databases such as http://epls.arnet.gov/ and http://exclusions.oig.hhs.gov/. The form is specifically associated with a VA shuttle services solicitation (Solicitation Number: 36C26226Q0004) for the Veterans Integrated Service Network 22, with vendors required to complete comprehensive business profile information for potential contract consideration.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C26226Q0004 0001.docx | DOCX document | |
| S02. 36C26226Q0004_1.docx | DOCX document | |
| Off Site Parking Garage.pdf | ||
| VA10091.pdf | ||
| 36C26226Q0004_1.docx | DOCX document | |
| Shuttle Signage.pdf | ||
| Shuttle Parking Location VAMC.pdf | ||
| W-9 Form.pdf |
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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/
File details come from the government source that posted it. Updated .