FMS Vendor File Update Request Form.pdf
PDF 236 KB Posted
- Attached to
- J043--PMR AIR COMPRESSORS & Pumps -w/wd
- Solicitation number
- 36C26225Q0600
About this file
The document is a Vendor File Update Request Form for the Department of Veterans Affairs (VA) Veterans Health Administration. The form collects comprehensive vendor information including contact details, tax identification, business type, socioeconomic status, and registration compliance. Key details include mandatory fields for Dun & Bradstreet number, Central Contractor Registration (CCR), and verification through exclusion websites to ensure vendor eligibility for federal government business.
The form is associated with Solicitation Number 36C26225Q0600 for PMR Air Compressors & Pumps, issued by Veterans Integrated Service Network 22. Vendors must indicate their business type, with options including small, large, and various socioeconomic categories such as small disadvantaged business, HUBZone, veteran-owned, and woman-owned businesses. Additional requirements include providing payment terms, purchase card acceptance status, and compliance checks through mandatory federal registration platforms to confirm the vendor's ability to conduct business with the government.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C26225Q0600_1.docx | DOCX document | |
| W-9 Form.pdf | ||
| VA10091.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 .