Records Storage

Form / Attachment / Pricing Sheet

This document, VA Form 10091, is the Vendor File Request Form used by the VA Financial Services Center (FSC). Its purpose is to gather essential payment data from vendors to establish or update vendor records for processing electronic payments, in accordance with Title 31 of the Code of Federal Regulation Part 208.

The form is divided into four sections:

• Section I: VA Facility Information: For internal VA use, collecting station number, contact details, and vendor type.
• Section II: Payee/Vendor Information: Collects details such as SAM.gov registration status, Unique Entity Identifier (UEI), EFT Indicator, Taxpayer Identification Number (TIN), NPI (for medical providers), business name (including DBA), contact information (email, phone), and current/previous addresses.
• Section III: EFT/ACH: Gathers current bank name, routing number, account number, and account type for direct deposit of payments.
• Section IV: Authorized Representative: Collects the name and title of the authorized representative and their signature, certifying the accuracy of the information provided.

Vendors responding to VA opportunities may be required to complete and submit this form to ensure they can receive electronic payments. It is crucial for vendors to ensure the information provided on this form matches their SAM.gov registration, particularly the UEI. Any changes to banking information must be made in SAM.gov. The form also outlines the certification requirements and penalties for false statements.

Solicitation / RFP / RFQ

This solicitation is a Request for Quotation (RFQ) for Records Storage and Maintenance services for the Phoenix VA Health Care System. The government requires off-site storage and management of administrative paper records from Sterile Processing Services (SPS) and Credentialing and Privileging (C&P) departments.

• Secure, climate-controlled off-site storage of administrative records.

• Records pickup and transportation to the secure facility.

• Maintenance of records in accordance with NARA standards.

• Retrieval and delivery of requested records upon request.

• Records disposition services in accordance with Federal and VA regulations.

• Compliance with all applicable Federal and VA records management laws and regulations, including NARA, Privacy Act of 1974, and VA Handbooks.

• Contract Type: Firm-Fixed-Price.

• Period of Performance: 5 years (1 base year and 4 option years).

• Estimated Value: Not explicitly stated, but the solicitation is for a "simplified acquisition procedure" and uses NAICS code 493110 with a size standard of $34 Million.

• Questions Due: April 16, 2026, by 1:00 PM MST.

• Offers Due: April 22, 2026, by 3:00 PM MST.

• Submission Method: Offers must be submitted via email to jasmon.cornick@va.gov in PDF format.

• Evaluation Factors:

  • Technical Approach (meeting SOW requirements for storage, retrieval, disposition).
  • Experience (past performance in records storage, including subcontractors).
  • Price (reasonableness of proposed price).
  • Required Documents (VA Form 10091, W-9, SAM registration, VAAR 852.219-75/-76 certifications).

• Basis of Award: Award will be made to the responsible offeror whose quote conforms to the solicitation, is found to be fair and reasonable, and does not exceed available funding. Price is not the sole evaluation factor.

• This acquisition is a total set-aside for Certified Service-Disabled Veteran-Owned Small Businesses (SDVOSBs).

• Offerors must be certified and listed in the SBA certification database.

• Specific limitations on subcontracting apply.

• Offerors must register in the System for Award Management (SAM).

• Specific instructions for accessing the Customer Engagement Portal (CEP) are provided.

• Failure to submit required documents or meet special standards of responsibility may result in ineligibility for award.

Form / Attachment / Pricing Sheet

This document is IRS Form W-9, Request for Taxpayer Identification Number and Certification. It is used by entities and individuals to provide their correct Taxpayer Identification Number (TIN) to a requester, which is necessary for the requester to file information returns with the IRS.

• Part I: Taxpayer Identification Number (TIN): Requires the entry of a Social Security Number (SSN) or Employer Identification Number (EIN).
• Part II: Certification: Requires the individual or entity to certify that the TIN provided is correct, that they are not subject to backup withholding (or are exempt), and that they are a U.S. citizen or other U.S. person.
• Lines 1-7: Collects name, business name (if applicable), address, city, state, ZIP code, and optional account numbers.
• Line 3a: Asks for the federal tax classification of the entity/individual.
• Line 3b: For partnerships, trusts, or estates, to indicate if there are foreign partners, owners, or beneficiaries.
• Line 4: For exemptions from backup withholding or FATCA reporting.

Bidders may be required to complete and submit this form to the government agency or prime contractor if they are selected for an award or to participate in certain contracting activities. Providing an incorrect TIN or failing to provide it can lead to backup withholding or other penalties. This form ensures the government has the correct identification for payment and tax reporting purposes.