FMS Vendor File Update Request Form.pdf

PDF 236 KB Posted

Attached to
N040--CLC Curtain Track Install Federal contract opportunity
Solicitation number
36C26225Q0708
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 22

About this file

The document is a Vendor Information form used by the Department of Veterans Affairs (VA) to collect comprehensive vendor details for potential business engagement. The form requires vendors to provide critical information including business name, contact information, tax identification, business type, socioeconomic status, and registration credentials. Key mandatory requirements include obtaining a D-U-N-S Number, registering with Central Contractor Registration (CCR), and verifying the vendor's eligibility to conduct federal business through specific government websites (epls.arnet.gov and exclusions.oig.hhs.gov). The form allows vendors to indicate their business classification, such as small business, disadvantaged business, veteran-owned, or woman-owned, and specifies whether they accept purchase cards and have existing contracts.

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Other files for this federal contract opportunity

Other files attached to N040--CLC Curtain Track Install, newest first.
File Type Posted
36C26225Q0708 0001.docx DOCX document
S02. Solicitation - 36C26225Q0708_1.pdf PDF
VA10091.pdf PDF
W-9 Form.pdf 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 .