FMS Vendor File Update Request Form.pdf
PDF 270 KB Posted
- Attached to
- Q301--New Require | IV Admixture Competency Testing Federal contract opportunity
- Solicitation number
- 36C26225Q0145
About this file
This is a Vendor Information Form used by the Department of Veterans Affairs (VA) to collect and verify vendor details for their procurement database. The form requires comprehensive vendor information including business name, tax identification numbers, address details, contact information, and payment terms.
The form includes critical compliance requirements such as mandatory registration in the Central Contractor Registration (CCR) system and DUN & Bradstreet, socioeconomic classifications (small/large business, veteran-owned, woman-owned, etc.), and 1099 vendor status. It also requires verification of existing contracts, FOB terms, prompt payment discounts, and purchase card acceptance. Before vendor information can be entered into the VA database, mandatory checks must be performed through specified government websites (epls.arnet.gov and exclusions.oig.hhs.gov) to verify the vendor's eligibility to conduct business with the federal government.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| RFQ - 36C26225Q0145 - IV Room Competency Testing.docx | DOCX document | |
| W-9 Form.pdf | ||
| VA Form 10091.pdf | ||
| 36C26225Q0145.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 .