FMS Vendor File Update Request Form.pdf
PDF 255 KB Posted
- Attached to
- M1FD--ASPIRE CENTER FOOD SERVICE
- Solicitation number
- 36C26226Q1336
About this file
This document is a Vendor Information Form used by the VA (Department of Veterans Affairs) to collect and verify vendor registration data for federal contracting purposes.
The form captures essential vendor identification and business information, including the requestor, vendor name, physical and mailing addresses, tax identification number (TIN) or social security number (SSN), phone, fax, email, and payment address. It requires vendors to provide a point of contact and account number, and asks whether the vendor has an existing contract with specified payment terms (N/30) and expiration dates. The form designates Free on Board (FOB) terms as either Destination or Origin and requests prompt payment discount information. Vendors must identify their business type under the Federal Procurement Data System (FPDS) categories (Small, Large, Outside VA, or Other Entities) and indicate applicable socioeconomic classifications including Small Disadvantaged Business, Veteran-Owned Small Business, Woman-Owned Small Business, HUBZone Small Business, Historically Black College/University, and Minority Institutions. The form requires mandatory registration verification through three federal databases: Dun and Bradstreet (DUNS number), Central Contractor Registration (CCR), the Excluded Parties List System (EPLS), and the HHS Office of Inspector General Exclusions database. Additional fields capture 1099 vendor indicator status, purchase card acceptance capability, and require confirmation that all mandatory registration checks have been completed before vendor data is entered into the VA database.
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Other files
| File | Type | Posted |
|---|---|---|
| W9 Request for Taxpayer Identification Number and Certification.pdf | ||
| VA10091 Vendor Request Form.pdf | ||
| 36C26226Q1336_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/
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File details come from the government source that posted it. Updated .