Vendor Registration Packet

WV-1A - VENDOR REGISTRATION AND DISCLOSURE STATEMENT AND SMALL, WOMEN-, AND MINORITY-OWNED BUSINESS CERTIFICATION APPLICATION. Before a vendor is eligible to sell goods and/or services to the State of West Virginia, the West Virginia Code §5A‐3‐12 requires all vendors to have on file with the West Virginia Purchasing Division a completed Vendor Registration and Disclosure Statement. Vendors supplying sole source goods or services to West Virginia state agencies, or competitive purchases of $2,500 or less annually in aggregate across all state agencies are required to complete the Vendor Registration and Disclosure Statement (WV‐1A form). If the amount for competitive purchases exceed $2,500 in aggregate across all state agencies in any one year, a $125.00 annual fee is required. Payment of the annual fee includes email notifications on bid opportunities based on the commodities and services selected upon registering in the Vendor Self‐Service (VSS) portal at wvOASIS.gov. Please complete Part I of this form in its ENTIRETY and return to the state agency listed below for their completion of Part II. The agency will forward this form to the West Virginia Purchasing Division for processing. Incomplete forms may not be processed and may be returned to the vendor. www.FormsWorkflow.com