FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Attached to
- F103--Base Year | Critical Water Testing Federal contract opportunity
- Solicitation number
- 36C26224Q0073
About this file
This document contains a vendor file update request form and details of a related federal contract opportunity for critical water testing services. The vendor form requests information such as company name, address, tax identification number, points of contact, and payment details. It also asks whether the vendor has an existing contract and if so requests contract and expiration details. Additional questions cover 1099 status, business type, socioeconomic certifications, acceptance of purchase cards, DUNS and CCR registration status, and verification of ability to do business with the federal government.
The associated federal opportunity is a solicitation from the Department of Veterans Affairs Veterans Health Administration VISN 22 for base year critical water testing services under solicitation number 36C26224Q0073. The opportunity type is listed as a solicitation but no further details are provided regarding required services, response date, award date, pricing or other salient information.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Question.pdf | ||
| 36C26224Q0073 0002_1.docx | DOCX document | |
| 36C26224Q0073 - Question _ Answers.docx | DOCX document | |
| 36C26224Q0073 0001_1.docx | DOCX document | |
| 36C26224Q0073 - Critical Water Testing.pdf | ||
| VA10091.pdf | ||
| 36C26224Q0073_1.docx | DOCX document | |
| W-9 Form.pdf |
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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 .