FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Solicitation number
- 36C26224Q0956
About this file
This document is a Vendor Information Request Form related to a federal contract opportunity issued by the Department of Veterans Affairs (VA) for a Solar Photovoltaic Power Monitoring System Replacement at the Jennifer Moreno VA Medical Center in San Diego, CA.
The key details of the federal contract opportunity are: The solicitation number is 36C26224Q0956, the NAICS code is 221114 with a small business size standard of 500 employees, and it is a SDVOSB set-aside. The VA is seeking quotations with a response deadline of May 22, 2024 at 12:00 PM PDT. All questions must be submitted in writing by May 14, 2024 at 2:00 PM PDT. The contract will be for the installation and monitoring of a solar photovoltaic power system at the medical center, as detailed in the attached Statement of Work. The vendor information request form collects details such as vendor name, address, tax ID, payment information, and socioeconomic status to determine eligibility for the set-aside.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Questions and Answers Solar PEV VA.pdf | ||
| 36C26224Q0956 0002.pdf | ||
| 36C26224Q0956 0002_1.docx | DOCX document | |
| 12818 San Diego VA O and M.pdf | ||
| 36C26224Q0956 0001_1.docx | DOCX document | |
| 36C26224Q0956 0001.pdf | ||
| SOL 6 11 004 RECORD DRAWINGS 5 23 2013.pdf | ||
| 36C26224Q0956_1.docx | DOCX document | |
| VA Form 10091.pdf | ||
| RFQ - 36C26224Q0956 - Solar PEV Replacement.pdf | ||
| W-9 Form.pdf |
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 .