FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Solicitation number
- 36C26224Q1577
About this file
This document is a Vendor File Update Request Form from the Department of Veterans Affairs. The form collects vendor information such as business name, physical and mailing addresses, tax identification number, payment address, point of contact, and payment terms. It asks if the vendor has an existing federal contract and to provide the contract number, beginning date, expiration date, FOB terms, and prompt payment discount. The form also captures the vendor's business type, socioeconomic status, and whether they accept purchase cards. Mandatory registrations with the Excluded Parties List System and System for Award Management are also required. The form is part of a federal contract opportunity with Solicitation Number 36C26224Q1577 for trouble shooting and repairing the VCS intrusion alarm and panic button system, set aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB).
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C26224Q1577 0002_1.docx | DOCX document | |
| Questions and Answers Intrusion and Panic Alarm System.pdf | ||
| Amendment - 36C26224Q1577 0001.pdf | ||
| 36C26224Q1577 0001_1.docx | DOCX document | |
| Intrusion and Panic Alarm System PHOTOS.pdf | ||
| 36C26224Q1577_1.docx | DOCX document | |
| RFQ 36C26224Q1577.pdf | ||
| W-9 Form.pdf | ||
| VA10079.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 .