FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Attached to
- H263-- ANNUAL FIRE DOORS INSPECTIONS | BASE Federal contract opportunity
- Solicitation number
- 36C26224Q1853
About this file
The document is a Vendor File Update Request Form that is used to update vendor information in the Department of Veterans Affairs (VA) database. It requires vendors to provide details such as their name, address, tax identification number, payment information, contact person, existing contract information, and socioeconomic business classifications. The form also mandates that vendors be registered in the Central Contractor Registration (CCR) and be checked against the Excluded Parties List System (EPLS) and the List of Excluded Individuals/Entities (LEIE) before their information can be entered into the VA's database. This is a standard administrative form required for all vendors seeking to do business with the VA.
The related federal contract opportunity is a solicitation for annual fire door inspections for the VA Veterans Integrated Service Network 22. This is a new requirement with no site visit planned. The solicitation number is 36C26224Q1853, and the contracting agency is the Department of Veterans Affairs Veterans Health Administration.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C26224Q1853 0001.pdf | ||
| Questions and Answers - Annual Fire Door Inspections.pdf | ||
| 36C26224Q1853_1 - Annual Fire Door Inspections.docx | DOCX document | |
| VA Form 10091.pdf | ||
| W-9 Form.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 .