FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Solicitation number
- 36C26226Q0439
About this file
This document is a Vendor Information Form used by the Veterans Affairs (VA) to collect and validate vendor registration data for federal contracting purposes.
The form requires vendors to provide comprehensive business information including requestor identification, service type, vendor name and legal business designations, physical and mailing addresses, tax identification numbers or social security numbers, contact information, and payment address details. Vendors must disclose existing federal contracts with payment terms and expiration dates, indicate whether they accept purchase cards, and specify their business type under the Federal Procurement Data System (FPDS) classification as small, large, outside VA, or other entities. The form includes mandatory fields for socioeconomic classifications, allowing vendors to identify as small disadvantaged businesses, veteran-owned businesses, women-owned businesses, HUBZone small businesses, historically black colleges and universities, or other qualifying categories. Critical mandatory requirements include obtaining a Dun and Bradstreet number, registering with the Central Contractor Registration (CCR) system, and passing verification checks through the Excluded Parties List System (EPLS) and the Office of Inspector General exclusions database. Additionally, vendors must confirm 1099 reporting status, with the default being "yes" except for federal government entities. This form serves as a prerequisite validation tool before vendor information can be entered into the VA database, ensuring compliance with federal contracting regulations and eligibility determinations.
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Other files
| File | Type | Posted |
|---|---|---|
| VA10091 Vendor Request Form.pdf | ||
| W9 Request for Taxpayer Identification Number and Certification.pdf | ||
| 36C26226Q0439_1.docx | DOCX document |
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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 .