FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Solicitation number
- 36C26226Q0785
About this file
This is a Vendor Information Form used by the Department of Veterans Affairs (VA) to collect and verify vendor registration and business details for federal contracting purposes.
The form captures essential vendor identification information including business name, physical and mailing addresses, tax identification number or social security number, and contact details. It requires vendors to provide payment address information, points of contact, and account numbers. The form documents existing contract status, including contract numbers, beginning and expiration dates, freight on board (FOB) terms, and prompt payment discount offerings. Section 12 requires 1099 vendor indicator status, with the notation that federal government entities are excluded from this requirement. Business classification is mandatory under section 13, requiring vendors to identify themselves as small, large, outside Virginia, or other entities per Federal Procurement Data System (FPDS) categories. Section 14 requests socioeconomic classification selection from categories including small disadvantaged business, veteran-owned small and large business, woman-owned small and large business, Javits-Wagner-O'Day, Hubzone small business, and historically black colleges and universities/minority institutes. The form mandates vendor registration in three systems prior to database entry: Dun and Bradstreet registration, Central Contractor Registration (CCR) at http://www.ccr.gov, and verification against exclusion lists at http://epls.arnet.gov/ and http://exclusions.oig.hhs.gov/. The form also captures purchase card acceptance capability and establishes mandatory compliance checks to ensure vendor eligibility to conduct business with the federal government.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C26226Q0785 0001_1.docx | DOCX document | |
| 36C26226Q0785 0001 02.docx | DOCX document | |
| VA10091.pdf | ||
| S02 - RFQ - 36C26226Q0785 - Tree Trimming.pdf | ||
| W-9 Form.pdf | ||
| 36C26226Q0785_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 .