FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Attached to
- J045--HYDROJETTING WITH A CAMERA SERVICES Federal contract opportunity
- Solicitation number
- 36C26226Q0924
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 requestor details, service type, vendor name, physical and mailing addresses, tax identification or Social Security number, and contact information. It requires vendors to provide payment address details, designate a point of contact, and disclose existing contract information including contract numbers, payment terms (such as N/30 or prompt payment discounts), and FOB terms. The form mandates three critical registrations and verifications: vendors must obtain a DUNS number from Dun & Bradstreet (http://www.dnb.com), register with the Central Contractor Registration (CCR) at http://www.ccr.gov, and be verified against two federal exclusion databases (http://epls.arnet.gov/ and http://exclusions.oig.hhs.gov/) before entry into the VA database. Additional required fields include business type classification per FPDS standards (Small, Large, Outside VA, or Other Entities), socioeconomic status indicators (such as Small Disadvantage Business, Veteran-Owned, Woman-Owned, Hubzone Small Business, and Historically Black College or University designations), 1099 vendor indicator status, and purchase card acceptance capability. The form emphasizes that failure to complete mandatory fields or check required registration sites could result in administrative action.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions Answer - Hydro-Jetting.docx | DOCX document | |
| 36C26226Q0924 0001.docx | DOCX document | |
| S02 - 36C26226Q0924 - Hydro-Jetting.pdf | ||
| VA10091.pdf | ||
| W-9 Form.pdf | ||
| 36C26226Q0924_1.docx | DOCX document |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .