Departments & Offices » Procurement » eVA » eVA Refusal Form

eVA Refusal Form

Please complete the information below before submitting this form. eVA is the Commonwealth of Virginia electronic procurement system. All vendors registered in eVA are the preferred source for goods and services purchased by the College of William and Mary (W&M) which includes the Virginia Institute of Marine Science (VIMS).

Instructions:

This form should be submitted only by an authorized agent of vendors that are NOT registered with eVA but have been requested by the College or VIMS to provide goods or services.
This form shall NOT be used by College staff to submit vendor eVA information.

Vendor Information:

star Vendor Name

star Address Line 1

Address Line 2

star City

star State:

Zip Code

star Authorized Agent Name

star Agent Title

star Agent Phone

Agent Fax

Agent E-Mail

eVA Fees

If you select "Vendor agrees to pay eVA fee":

Although refusing to join eVA (http://www.eva.state.va.us/), the firm or individual accepts eVA Terms and Conditions regarding transaction fees for an order from the College of William and Mary, understanding that these terms include the agreement to pay an eVA transaction fee. The fee is 1% capped at $500 per order if certified-SWaM, or $1500 for all non-SWaM vendors, for which vendor will be invoiced by the Department of General Services (DGS) of the Commonwealth of Virginia.

If you select "Vendor refuses to pay eVA fee":

Firm or individual is not an eVA registered vendor and refuses to accept eVA Terms and Conditions regarding transaction fees for an order from the College of William and Mary. The firm or individual understands that the College is prohibited by State mandate from purchasing from refusing vendors unless justified by the using department and approved as a sole source by the Office of Procurement.

star Please select one:

Vendor agrees to pay eVA fee

Vendor refuses to pay eVA fee

By submission of this form, the agent confirms that he/she is an authorized agent of the vendor.

Please print a copy for your records BEFORE you submit. You may submit this form online by clicking on Submit below.

If submitting by FAX, please print a copy and fax to 757-221-3959, Attn: e-Procurement Officer.

If submitting by MAIL, please print a copy and mail to: College of William and Mary, Office of Procurement, Attn: e-Procurement Officer, PO Box 8795, Williamsburg, VA 23187-8795.

If submitting this form by fax or mail, please sign and date this form on the line below.

Authorized Agent Signature and Date

Please print a copy for your records BEFORE pressing Submit.

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