FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Solicitation number
- 36C26226Q0701
About this file
This is a Vendor Information Form used by the Department of Veterans Affairs (VA) to collect and validate vendor registration data for federal contracting purposes.
The form captures essential vendor identification details including the requestor, vendor name, doing business as/legal name, physical and mailing addresses, tax identification number or social security number, phone and fax contact information, and email address. It also requires a separate payment street address and point of contact information. The form inquires whether the vendor has an existing contract, and if so, requests the contract number, beginning date, expiration date, FOB terms (destination or origin), and prompt payment discount terms (such as 2%/10, 1%/20, or N/30). Additional mandatory fields include 1099 vendor indicator status, business type classification under FPDS (small, large, outside VA, or other entities), socioeconomic group designations (small disadvantage business, veteran-owned, woman-owned, HUBZone, JWOD, historically black college/university, or other), purchase card acceptance capability, and DUN and Bradstreet number. The form requires vendors to be registered with the Central Contractor Registration (CCR) system and mandates that VA staff verify vendor eligibility through two federal databases—the Excluded Parties List System (EPLS) at http://epls.arnet.gov/ and the HHS Office of Inspector General Exclusions List at http://exclusions.oig.hhs.gov/—before entering new vendor information into the VA database.
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Other files
| File | Type | Posted |
|---|---|---|
| VA10091.pdf | ||
| W-9 Form.pdf | ||
| 36C26226Q0701_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 .