FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Attached to
- H342--Fire Extinguisher Inspection, Maintenance, and Testing Federal contract opportunity
- Solicitation number
- 36C26224Q1695
About this file
The document provided is a Vendor File Update Request Form. It collects key information about a vendor, including business details, tax identification, payment information, and existing contract information. The form also verifies the vendor's registration status with the Central Contractor Registration (CCR) and checks for the vendor's inclusion on the Excluded Parties List System.
The related federal contract opportunity is for Fire Extinguisher Inspection, Maintenance, and Testing services, solicited by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22. The solicitation number is 36C26224Q1695. The document does not provide any details about the required products or services, response dates, award information, pricing terms, or set-asides. It appears to be a vendor information form rather than the solicitation itself.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C26224Q1695 0001.docx | DOCX document | |
| VA10091.pdf | ||
| W-9 Form.pdf | ||
| 36C26224Q1695_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/
File details come from the government source that posted it. Updated .