FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Solicitation number
- 36C26224Q0900
About this file
This document is a Vendor Information Form that is used to update vendor information in a federal agency's database. The form captures details such as the vendor's name, address, tax ID, point of contact, payment information, and whether the vendor has an existing federal contract. It also requires the vendor to indicate its business type, socioeconomic status, and whether it accepts purchase cards. Mandatory registration requirements, such as obtaining a DUNS number and registering with the Central Contractor Registration (CCR) system, are also noted.
The related federal contract opportunity is for the replacement of boiler feed water system variable frequency drives, pumps, and motors at the VA San Diego Healthcare System. This is a SDVOSB set-aside solicitation with a NAICS code of 561210 and a small business size standard of $47 million. The solicitation number is 36C26224Q0900, and responses are due by May 17, 2023, at 12:00 PM PDT. All questions must be submitted by May 8, 2023, at 3:00 PM PDT.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Boiler Feedwater System Questions and Answers 2.docx | DOCX document | |
| 36C26224Q0900 0003_1.docx | DOCX document | |
| 36C26224Q0900 0003.pdf | ||
| Boiler Feedwater System Questions and Answers.docx | DOCX document | |
| 36C26224Q0900 0002_1.docx | DOCX document | |
| 36C26224Q0900 0002.pdf | ||
| 36C26224Q0900 0001_1.docx | DOCX document | |
| RFQ - 36C26224Q0900 - Boiler Maintenance.pdf | ||
| W-9 Form.pdf | ||
| VA Form 10091.pdf | ||
| 36C26224Q0900_1.docx | DOCX document |
Show all 11
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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 .