FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Solicitation number
- 36C26224Q0381
About this file
This document is a Request for Quotations (RFQ) for Emergency Eyewash Station Repair Services at the Jennifer Moreno VA Medical Center in San Diego, CA. The solicitation is a small business set-aside under NAICS code 238220 with a $19M size standard. The Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 22 is seeking quotes for the required services. All quotations must be submitted by email to the Contracting Officer by March 27, 2024 at 12:00 PM PST. The Statement of Work provides further details on the required services. No further questions will be accepted after March 25, 2024 at 12:00 PM PST.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26224Q0381 0004.pdf | ||
| 36C26224Q0381 0004_1.docx | DOCX document | |
| IMG_0092.jpeg | JPEG file | |
| IMG_0091.jpeg | JPEG file | |
| IMG_0096.jpeg | JPEG file | |
| IMG_0094.jpeg | JPEG file | |
| IMG_0093.jpeg | JPEG file | |
| IMG_0095.jpeg | JPEG file | |
| 36C26224Q0381 0003.pdf | ||
| 36C26224Q0381 0003_1.docx | DOCX document | |
| Questions and Answers - 664 - Eyewash Station Repair and Maintenance.docx | DOCX document | |
| Site-visit Information.docx | DOCX document | |
| 36C26224Q0381 0002_1.docx | DOCX document | |
| 36C26224Q0381 0001_1.docx | DOCX document | |
| 36C26224Q0381 0001.docx | DOCX document | |
| 36C26224Q0381_1.docx | DOCX document | |
| RFQ - 36C26224Q0381 Emergency Eyewash Station Repairs.pdf | ||
| W-9 Form.pdf | ||
| VA Form 10091.pdf |
Show all 19
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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 .