FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Attached to
- R425--RFQ | SBAR APPROVED | Fire Sprinkler Inspection, Maintenance & Repairs WD REQUIRED
- Solicitation number
- 36C26226Q0884
About this file
This is a Vendor Information Form used by the Veterans Affairs (VA) to collect comprehensive vendor registration and eligibility data for federal contracting purposes.
The form requires vendors to provide standard identification information including requestor details, vendor name, physical and mailing addresses, tax identification number or social security number, phone/fax contact information, and payment address. Vendors must disclose whether they hold existing contracts and provide associated contract numbers, beginning dates, expiration dates, and payment terms (such as FOB terms and prompt payment discounts). The form mandates collection of the vendor's DUN and Bradstreet number and confirmation of Central Contractor Registration (CCR) enrollment, both required for federal government business eligibility. Additionally, vendors must indicate their 1099 status (marked "Always YES except if FEDERAL Government"), business type classification under FPDS standards (Small, Large, Outside VA, or Other Entities), and applicable socioeconomic designations including small disadvantaged business, veteran-owned small or large business, service-disabled veteran-owned, women-owned small or large business, HUBZone small business, and historically black colleges/universities or minority institutes. The form also captures whether the vendor accepts purchase cards. Before vendor information may be entered into the VA database, mandatory compliance verification must be completed through http://epls.arnet.gov/ and http://exclusions.oig.hhs.gov/ to confirm the vendor's ability to conduct business with the federal government and ensure no administrative action is warranted.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C26226Q0884 0002_1.docx | DOCX document | |
| P0001 - Site Visit Announcement - Fire Sprinkler.docx | DOCX document | |
| 36C26226Q0884 - Questions and Answers.docx | DOCX document | |
| 36C26226Q0884 0001.docx | DOCX document | |
| S02 - RFQ - 36C26226Q0821 - Fire Sprinkler.pdf | ||
| W-9 Form.pdf | ||
| VA10091.pdf | ||
| 36C26226Q0884_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 .