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The New York Questionnaire form, a critical tool for vendors wishing to engage in business with New York City, serves to collect essential information that ensures compliance with the city's procurement standards. This form, part of the Vendor Information Exchange System (VENDEX), includes two primary components: the Vendor Questionnaire and the Principal Questionnaire. Each section is designed to gather comprehensive details about the vendor's business operations, ownership structure, and financial status. Effective as of September 25, 2014, the questionnaires are now fillable, allowing for easier data entry, although vendors must still print and submit paper copies. Specific formatting requirements must be adhered to, such as date fields needing to follow the MM/DD/YYYY format and identification numbers requiring nine digits without dashes. Vendors are expected to provide complete and accurate responses, as any omissions or unauthorized alterations can lead to rejection of the submission. The form emphasizes the importance of thoroughness, with instructions to attach additional pages if necessary. For assistance, vendors can consult the “Vendor’s Guide to VENDEX,” available online or through the VENDEX Unit. This guide offers clarification on terms and provides further insights into the questionnaire's requirements.

Similar forms

The New York Questionnaire form is essential for vendors wishing to conduct business with New York City. Several other documents serve similar purposes, helping to gather necessary information about vendors and their qualifications. Here are seven documents that share similarities with the New York Questionnaire:

  • Vendor Questionnaire: This document collects detailed information about the vendor's business operations, financial status, and ownership structure, just like the New York Questionnaire.
  • Principal Questionnaire: Similar to the New York Questionnaire, this form focuses on the individuals who hold key positions within the vendor organization, ensuring accountability and transparency.
  • Certification of No Change: This document allows vendors to confirm that their information remains unchanged, paralleling the need for accurate and updated vendor data in the New York Questionnaire.
  • Business License Application: Like the New York Questionnaire, this application requires vendors to disclose important business information to obtain the necessary permits to operate legally.
  • Tax Identification Form: This form collects essential tax-related information, ensuring compliance with state and federal regulations, similar to how the New York Questionnaire gathers vendor identification details.
  • Conflict of Interest Disclosure: This document seeks to identify any potential conflicts in business relationships, akin to the New York Questionnaire’s inquiries about ownership and affiliations.
  • Financial Disclosure Statement: This statement requires vendors to provide financial information, which is a critical aspect of the New York Questionnaire aimed at assessing the vendor's financial viability.

Each of these documents plays a vital role in ensuring that vendors meet the necessary criteria to engage in business with New York City, thereby promoting responsible vendor practices.

Form Preview

Bill de Blasio

Mayor

Lisette Camilo

City Chief Procurement

Officer and Director of

Contract Services

253 Broadway, 9th Floor

New York, NY 10007

212 788 0010 tel

212 788 0049 fax

September 25, 2014

Please note that effective, September 25, 2014, the VENDEX questionnaires are now fillable. YOU WILL STILL NEED TO COMPLETE, PRINT AND SUBMIT THE PAPER COPIES. These include the:

Vendor Questionnaire

Principal Questionnaire

Certification of No Change

Please be advised that certain fields require certain types of entry, e.g.:

Date fields require entries to match: MM/DD/YYYY

Telephone/Fax fields require entries to match: XXX-XXX-XXXX or (XXX) XXX-XXXX

EIN/TIN/SSN fields require 9 digits and no dashes

SSN only fields require entries to match XXX-XX-XXXX

Please also note that not all the fields will match the underlying formatting due to the limitations of the form, but ALL information will be able to be inputted. If you have any questions or concerns with the form, please email us at VENDEXFEEDBACK@cityhall.nyc.gov and we will get back to you as soon as possible.

PLEASE NOTE THAT ALTHOUGH THE FORMS ARE FILLABLE, YOU WILL STILL NEED TO

COMPLETE, PRINT AND SUBMIT THE PAPER COPIES.

Thank you for your kind consideration.

Printed on paper containing 30% post-consumer material.

Vendor Questionnaire FILLABLE 9/25/14

 

Revised 9/25/14

Page 1 of 20

Submitting vendor’s EIN/SSN/TIN

 

VENDOR QUESTIONNAIRE

The Vendor Information Exchange System (VENDEX) includes two questionnaires – the vendor questionnaire and the principal questionnaire. These have been developed to collect information from vendors who wish to do business with New York City, to ensure that New York City obeys the mandate in its charter to do business only with responsible vendors.

Questionnaires may be obtained in paper format from the VENDEX Unit (212-341-0933) or downloaded from the NYC website at http://www.nyc.gov/vendex.

Questionnaires must be completed in paper format. All questions must be answered. A response of “Not Applicable (N/A)”, or the equivalent, is not acceptable. Answers must be typewritten or printed in ink. If more space is needed to respond, photocopy the corresponding section’s page, check the box that additional information is attached, and attach the photocopied page to the questionnaire.

The publication “Vendor’s Guide to VENDEX” provides assistance and explanation for the questionnaires, including definitions of terms or phrases written in bold face throughout the questionnaires. If you have not obtained a copy of this publication, please download a copy from the New York City web site, or contact the VENDEX Unit at 212-341-0933. All forms must be sent to MOCS: 253 Broadway, 9th Floor; New York, New York 10007. If you have questions, contact the VENDEX Unit at 212-341-0933.

ANSWER THIS QUESTIONNAIRE CAREFULLY AND COMPLETELY. FAILURE TO SUBMIT A FULLY COMPLETED QUESTIONNAIRE MAY RESULT IN THE REJECTION OF THE VENDEX SUBMISSION. MAKING

ANY UNAUTHORIZED CHANGE OR ALTERATION TO THE

QUESTIONNAIRE WILL RENDER IT VOID.

Name of submitting vendor

 

 

 

Submitting Vendor’s EIN/ SSN/TIN: ____________________

 

Submitting vendor is

Prime

Parent

Controlling entity

Subcontractor

Type of submission: (Check one)

1.

2.

Full questionnaire

 

 

Changed questionnaire

 

 

If checked, provide submission date of last full questionnaire:

/

/

Name of person completing this vendor questionnaire

Employer/Title

Telephone Number (

 

)

 

-

 

Fax Number (

)

-

 

 

 

 

 

 

 

 

 

 

 

Email address

The disclosure of the social security number is mandatory under the right granted New York City by the Tax Reform Act of 1976 and will be used for the purpose of tax administration. The number may also be used for general identification purposes. If you do not consent to such additional use for general identification purposes, please check here

Vendor Questionnaire

 

Revised 9/25/14

Page 2 of 20

Submitting vendor’s EIN/SSN/TIN

 

1.Submitting vendor’s:

a.Principal executive office address

Street/P.O. Box

 

 

 

 

 

 

 

 

Floor #/Suite #

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip Code

 

 

 

 

 

 

 

 

 

 

 

Telephone Number (

 

)

 

-

 

Fax Number (

 

)

 

-

 

b.Primary place of business (in the NYC metropolitan area)

Street/P.O. Box

 

 

 

 

 

 

 

 

Floor #/Suite #

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip Code

 

 

 

 

 

 

 

 

 

 

 

Telephone Number (

 

)

 

-

 

Fax Number (

 

)

 

-

 

Check if the submitting vendor had other primary places of business in the NYC metropolitan area within the prior five (5) years and list information on page 7.

c.Primary place of business address is (check all that apply)

 

Owned

 

Rented

 

Rented with an option to buy

 

Donated

 

 

 

 

 

 

 

 

d.Addresses of the three largest sites at which it is anticipated that work would occur in connection with the contract pending at the times this questionnaire is completed, based on the number of people to be employed at each site:

 

 

address in 1a. (if applicable)

 

 

 

address in 1b. (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional site(s)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/P.O. Box

 

 

 

 

 

 

 

 

 

 

 

Floor #/Suite #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number (

 

)

 

 

-

 

 

Fax Number (

 

)

 

-

 

Check if submitting vendor’s three largest sites include other addresses and list information on page 7.

e.Web site address www.

f.Annual gross revenue (check range that applies)

 

 

$0 - $99,999

 

$100,000 - $499,999

 

 

 

$500,000 – $999,999

 

 

 

 

 

 

 

 

$1,000,000 - $ 2,499,999

 

$2,500,000 –$4,999,999

 

 

$5,000,000 or more

 

 

 

 

g.Business category (check all that apply)

 

 

 

Professional services

 

Manufacturing

 

Construction

 

 

 

Human Services

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Commercial Services

 

Distribution

 

 

Retail

 

 

 

 

Not-for-Profit

 

Submitting vendor’s

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

h.

DUNS number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

none

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

i.

National or regional stock exchange or NASDAQ listing

 

 

 

 

 

 

 

 

 

 

 

none

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

j.

Date submitting vendor began business in New York City

/

/

 

 

 

 

 

 

 

 

 

Check if additional information is attached

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Provide a detailed response to all questions answered with information and/or “YES” in the question’s corresponding section starting on page 7 of this questionnaire.

 

Vendor Questionnaire

 

Revised 9/25/14

 

 

Page 3 of 20

 

 

 

Submitting vendor’s EIN/SSN/TIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

No

 

 

Yes

Does the submitting vendor now use, or has it in the past ten (10) years

 

 

 

 

 

 

 

 

 

 

 

used, an EIN, TIN, SSN or DBA, trade name or abbreviation other than

 

 

 

 

 

 

 

 

 

 

 

the submitting vendor name or EIN/SSN/TIN number listed on page 1 of

 

 

 

 

 

 

 

 

 

 

 

this questionnaire?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

 

No

 

 

Yes

Has the submitting vendor used any other business addresses

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and telephone numbers at any time during the prior five (5) years?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4a.

Date this business was formed ____ / ____ /____

State in which business was formed ________________________

County in which business was formed _______________________

Country in which business was formed (if not formed in USA) _____________________

Type of organization (check one):

_____ Business Corporation

_____ Not-for Profit Corporation

_____ Sole Proprietorship

_____ Partnership: ____ General ____ Limited _____ Limited Liability

_____ Limited Liability Company

_____ Joint Venture

_____ Other-indicate type: _____________________________________________

4b.

 

No

 

Yes

Are there any counties in New York State, other than the county listed

 

 

 

 

 

in response to question 4a, in which the submitting vendor has filed a

 

 

 

 

 

certificate of incorporation, a DBA, or the equivalent?

Provide a detailed response to all questions answered with information and/or “YES” in the question’s corresponding section starting on page 7 of this questionnaire.

Vendor Questionnaire

 

Revised 9/25/14

Page 4 of 20

 

 

Submitting vendor’s EIN/SSN/TIN

 

 

 

 

 

 

 

 

 

 

5.

 

 

 

 

 

 

 

 

 

a.

 

No

 

Yes

Does the submitting vendor share office space, staff, equipment, or

 

 

 

 

 

 

 

 

 

expenses with any other entities?

 

 

 

 

 

 

 

b.

 

 

No

 

Yes

Does the submitting vendor anticipate using or occupying any real

 

 

 

 

 

 

 

property, other than the business addresses listed in response to

 

 

 

 

 

 

 

Question 1 and 3, during the three (3) year VENDEX cycle?

c.

 

No

 

 

Yes

Does any principal owner or officer of the submitting vendor, or any

 

 

 

 

 

 

 

 

 

 

member of his/her immediate family, have an ownership interest in any

entity that holds the title or lease to any real property used by the submitting vendor in the New York City metropolitan area?

6.

a.Starting on page 8, list ALL of the submitting vendor’s principal owners and the three officers who exercise the most substantial degree of control over the submitting vendor.

b.

 

No

 

Yes

Pursuant to any stock option or any other arrangements, does any

 

 

 

 

 

individual or entity have the right within the next three (3) years to

 

 

 

 

 

acquire stock in the submitting vendor, which, when combined with

 

 

 

 

 

current holdings, would make such an individual or entity a principal

 

 

 

 

 

owner or officer?

c.

 

No

 

Yes

Is ten (10) percent or more of the submitting vendor’s stock or

 

 

 

 

 

 

 

ownership currently used or pledged as collateral for any loan or

 

 

 

 

 

obligation?

7.Are there any individuals now serving in a managerial or consulting capacity to the submitting vendor, whether or not as a principal owner or officer, who now serve, or within the past five (5) years have served as:

a.

 

 

No

 

Yes

an elected or appointed public official or officer?

 

 

 

 

 

 

 

 

 

 

b.

 

 

 

 

No

 

Yes

a full or part-time employee in a New York City agency or as a

 

 

 

 

 

 

 

 

 

 

consultant to any New York City agency?

 

 

 

 

 

 

 

 

 

c.

 

 

 

No

 

Yes

an officer of any political party organization in New York City, whether

 

 

 

 

 

 

 

 

 

 

paid or unpaid?

 

 

 

 

 

 

 

 

d.

 

 

No

 

Yes

as a consultant or advisor to a New York City agency performing

 

 

 

 

 

 

 

 

 

 

services related to the solicitation, negotiation, operation and/or

 

 

 

 

 

 

 

 

 

 

administration of contracts on which the submitting vendor will work

 

 

 

 

 

 

 

 

 

 

during this three (3) year VENDEX cycle?

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

 

 

No

 

Yes

Does the submitting vendor control one or more entities?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

No

 

Yes

Does the submitting vendor have one or more affiliates, and/or is it a

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

subsidiary of, and controlled by any other entity?

Provide a detailed response to all questions answered with information and/or “YES” in the question’s corresponding section starting on page 7 of this questionnaire.

Vendor Questionnaire

 

Revised 9/25/14

Page 5 of 20

 

 

Submitting vendor’s EIN/SSN/TIN

 

 

 

 

 

 

 

 

10.

 

No

 

Yes

Has the submitting vendor, or any affiliate listed in response to

 

 

 

 

 

 

 

Question 9, been a subcontractor on any contract with any New York

 

 

 

 

 

City agency in the past three (3) years?

11.At any time during the past five (5) years, has the submitting vendor or any of its affiliates, been subject to any of the following actions, whether pending or completed:

a.

 

No

 

 

 

Yes

debarred from entering into any government contract?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b.

 

 

 

 

 

No

 

 

 

 

 

Yes

found non-responsible on any government contract?

 

 

 

 

 

 

 

 

 

 

 

 

 

c.

 

 

 

No

 

 

 

Yes

declared in default and/or terminated for cause?

 

 

 

 

 

 

 

 

 

 

 

d.

 

 

No

 

 

 

Yes

determined to be ineligible to bid or propose on any contract?

e.

 

No

 

 

Yes

suspended from bidding or entering into any government contract?

 

 

 

 

 

 

 

 

 

 

f.

 

 

No

 

 

Yes

received an overall unsatisfactory performance rating from any

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

government agency on any contract?

12.Are there or have there been any judgments, injunctions, or liens, including, but not limited to, judgments based on taxes owed, fines and penalties assessed by any government agency, elected official, or the New York City Council initiated against the submitting vendor and/or any affiliate:

a.

 

No

 

Yes

at any time within the past five (5) years?

 

 

 

 

 

 

 

 

 

b.

 

 

No

 

 

 

Yes

that remain open, unsatisfied, or in effect today?

 

 

 

 

 

 

 

 

 

13.

 

 

No

 

 

Yes

Have any bankruptcy proceedings been initiated by or against the

 

 

 

 

 

 

 

 

 

 

 

 

submitting vendor or its affiliates within the past seven (7) years (whether

 

 

 

 

 

 

 

 

or not closed) or is any bankruptcy proceeding pending by or against the

 

 

 

 

 

 

 

 

submitting vendor or its affiliates regardless of date of filing?

14.In the past five (5) years, has the submitting vendor, any of its principal owners or officers, or any affiliate:

a.

 

No

 

Yes

had any permit, license, concession, franchise or lease terminated for

 

 

 

 

 

 

 

 

cause or revoked?

 

 

 

 

 

 

 

 

b.

 

 

No

 

 

 

Yes

been disqualified for cause as a bidder on any permit, license,

 

 

 

 

 

 

 

 

concession, franchise or lease?

 

 

 

 

 

 

 

 

 

15.

 

 

No

 

 

Yes

In the past five (5) years, have any of the submitting vendors or any of

 

 

 

 

 

 

 

 

 

 

 

 

the submitting vendors’ affiliates or any individual currently or within

 

 

 

 

 

 

 

 

that period serving as a principal owner, officer or managerial

 

 

 

 

 

 

 

 

employee been investigated by any government agency, including,

 

 

 

 

 

 

 

 

but not limited to, federal, state and local regulatory agencies?

Provide a detailed response to all questions answered with information and/or “YES” in the question’s corresponding section starting on page 7 of this questionnaire.

Vendor Questionnaire

 

Revised 9/25/14

Page 6 of 20

Submitting vendor’s EIN/SSN/TIN

 

16.Has the submitting vendor, any affiliate, or any of their current or former principal owners or officers or managerial employees:

a.

 

No

 

Yes

been convicted of a misdemeanor and/or found in violation of any

 

 

 

 

 

 

 

 

administrative, statutory, or regulatory provisions in the past five (5)

 

 

 

 

 

 

 

 

years?

b.

 

No

 

 

Yes

been convicted of a felony, and/or any crime related to truthfulness

 

 

 

 

 

 

 

 

 

 

 

and/or business conduct in the past ten (10) years?

c.

 

No

 

Yes

have any felony, misdemeanor and/or administrative charges currently

 

 

 

 

 

 

 

 

 

 

pending?

 

 

 

 

 

 

 

 

 

17.

 

 

No

 

Yes

For the past five (5) years, has the submitting vendor or any of its

 

 

 

 

 

 

 

 

 

 

 

principal owners, officers, or any affiliate had any sanction imposed

 

 

 

 

 

 

 

 

as a result of judicial or administrative disciplinary proceedings with

 

 

 

 

 

 

 

 

respect to any professional license held?

 

 

 

 

 

 

 

 

 

18.

 

 

No

 

 

Yes

Other than the submitting vendor’s employees, did the submitting

 

 

 

 

 

 

 

 

 

 

 

 

vendor retain, employ or designate anyone to influence the preparation

 

 

 

 

 

 

 

 

of contract specifications, or the solicitation or award of any contract

 

 

 

 

 

 

 

 

during this three (3) year VENDEX cycle?

 

 

 

 

 

 

 

 

 

19.

 

 

 

 

 

 

 

 

a.

 

No

 

Yes

Is the submitting vendor exempt from income taxes under the Internal

 

 

 

 

 

 

 

 

 

 

Revenue Code?

 

 

During the past five (5) years, has the submitting vendor failed to:

b.

 

No

 

Yes

file any applicable federal, state or New York City tax returns?

 

 

c.

 

No

 

Yes

pay any applicable federal, state or New York City taxes or other

 

 

 

 

 

 

 

 

 

 

assessed New York City charges, including but not limited to water and

 

 

 

 

 

 

 

 

sewer charges?

 

 

 

 

 

 

 

 

 

This question applies to not-for-profit vendors, others please answer “no”.

20. No Yes If the submitting vendor is a not-for-profit corporation, in the past three (3) years, have any audits of the submitting vendor revealed material weaknesses in its system of internal controls, compliance with contractual agreements and/or laws and regulations?

Provide a detailed response to all questions checked “YES” from pages one–six. If you need more space to respond, photocopy the corresponding section’s pages, check the box that additional information is attached, and attach the photocopied page to this questionnaire.

Vendor Questionnaire

 

Revised 9/25/14

Page 7 of 20

Submitting vendor’s EIN/SSN/TIN

 

Provide details to questions answered “yes” in the corresponding section below.

Corresponds to Question 1.

1b. Submitting vendor’s other primary place(s) of business

Street/P.O. Box

 

 

 

 

 

 

 

 

Floor #/Suite #

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip Code

 

 

 

 

 

 

 

 

 

 

 

Telephone Number (

 

)

 

-

 

Fax Number (

 

)

 

-

 

1d. Submitting vendor’s largest sites

Street/P.O. Box

 

 

 

 

 

 

 

 

 

Floor #/Suite #

 

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

(

 

)

 

-

 

Fax Number (

 

)

 

-

 

 

 

 

 

 

 

 

 

 

 

 

Street/P.O. Box

 

 

 

 

 

 

 

 

 

Floor #/Suite #

 

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

(

 

)

 

-

 

Fax Number (

 

)

 

-

 

Check if attaching additional information

Corresponds to Question 2.

Other DBA, name, trade name, abbreviation

Other EIN/TIN/SSN

 

 

 

 

 

Dates in use - from

/

/

to

/

/

Still in use

Check if attaching additional information

Corresponds to Question 3.

Other business addresses and telephone numbers in the last five (5) years

(Check One)

Current

Former

Street/P.O. Box

 

 

 

 

 

 

 

 

Floor #/Suite #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

Main telephone number (

 

)

 

-

 

Main fax number (

 

)

 

-

 

 

Check if attaching additional information

Corresponds to Question 4. (check all that apply)

4b.

Certificate of incorporation Other, please identify

DBA

County

 

 

Date

 

/

 

/

 

 

 

 

 

 

 

 

 

Check if attaching additional information

 

 

 

 

 

 

Provide a detailed response to all questions checked “YES” from pages one–six. If you need more space to respond, photocopy the corresponding section’s pages, check the box that additional information is attached, and attach the photocopied page to this questionnaire.

Vendor Questionnaire

 

 

 

 

 

 

 

 

 

Revised 9/25/14

Page 8 of 20

 

 

 

 

Submitting vendor’s EIN/SSN/TIN

 

 

 

 

 

 

 

 

 

 

 

 

 

Corresponds to Question 5. (check all that apply)

 

 

 

 

 

 

 

5a. Item(s) shared

 

Space

 

Staff

 

 

Equipment

 

Expenses

 

 

 

 

 

Other entity’s name ___________________________________________________

Other entity’s EIN/TIN/SSN __________________________

 

 

 

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/P.O. Box

 

 

 

 

 

 

 

 

 

Floor #/Suite #

City/State/Zip Code

Check if attaching additional information

5b. Address

Street/P.O. Box

Floor #/Suite #

City/State/Zip Code

Additional addresses to be used not yet known

Check if attaching additional information

5c. Ownership interest is

 

principal owner

officer

immediate family

Name of party with ownership interest

Name of entity holding title or lease

Check if attaching additional information

Corresponds to Question 6.

 

 

 

 

6a.

Principal owner’s name

 

 

 

 

 

EIN/SSN

Date of birth

/

/

Percent of ownership

 

individual

partnership

joint venture

 

corporation

 

Principal owner’s name

 

 

 

 

 

EIN/SSN

Date of birth

/

/

Percent of ownership

 

individual

partnership

joint venture

 

corporation

 

Principal owner’s name

 

 

 

 

 

EIN/SSN

Date of birth

/

/

Percent of ownership

 

individual

partnership

joint venture

 

corporation

 

Check if attaching additional information

 

 

 

 

Provide a detailed response to all questions checked “YES” from pages one–six. If you need more space to respond, photocopy the corresponding section’s pages, check the box that additional information is attached, and attach the photocopied page to this questionnaire.

 

 

Vendor Questionnaire

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Revised 9/25/14

 

 

 

 

Page 9 of 20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Submitting vendor’s EIN/SSN/TIN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Question 6 continued.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6a.

Officer’s name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

cont. SSN

 

 

-

 

 

 

-

 

 

 

 

 

 

 

 

Date of birth

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Officer’s name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN

 

 

-

 

 

 

-

 

 

 

 

 

 

 

 

Date of birth

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Officer’s name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SSN

 

 

-

 

 

 

-

 

 

 

 

 

 

 

 

Date of birth

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check if attaching additional information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6b.

 

 

 

Individual

 

 

 

 

 

Entity

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EIN/SSN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If individual, date of birth

 

/

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stock option

 

 

Other (explain)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Percent of ownership:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If entity is checked, is the business address the same as that listed in question 1?

 

 

 

Yes

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If no, list address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street/P.O. Box

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Floor #/Suite #

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City/State/Zip Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Main telephone number (

 

 

)

 

 

 

 

-

 

 

Main fax number (

 

)

 

 

 

 

 

-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check if attaching additional information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6c.

 

(Check all that apply)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stock

Ownership:

Used Loan

Pledged as collateral Obligation

Other (explain)

Name of receiving individual and/or entity ___________________________________

EIN/SSN

 

If individual, date of birth

/

/

 

 

 

 

 

 

 

 

 

 

 

Percent of ownership:

 

 

Transaction date

 

/

/

 

 

 

 

 

 

 

 

 

 

 

 

 

Check if attaching additional information

Provide a detailed response to all questions checked “YES” from pages one–six. If you need more space to respond, photocopy the corresponding section’s pages, check the box that additional information is attached, and attach the photocopied page to this questionnaire.

Common mistakes

When filling out the New York Questionnaire form, individuals often make several common mistakes that can lead to complications in the submission process. One prevalent error is failing to complete all required fields. Every question on the form must be answered; a response of "Not Applicable" is not acceptable. This oversight can result in the rejection of the entire submission.

Another frequent mistake involves incorrect formatting of information. Specific fields, such as dates and telephone numbers, have strict formatting requirements. For example, date fields must follow the MM/DD/YYYY format, while telephone and fax numbers should be entered as XXX-XXX-XXXX or (XXX) XXX-XXXX. Not adhering to these guidelines can cause delays or issues with processing the questionnaire.

Many individuals also neglect to provide their EIN, TIN, or SSN in the correct format. These fields require nine digits with no dashes. Errors in this area can lead to significant identification issues, which may hinder the vendor's ability to do business with New York City.

Additionally, some submitters fail to attach supplementary information when necessary. If more space is needed for responses, individuals should photocopy the relevant section and check the box indicating that additional information is attached. Omitting this step can leave critical information unaddressed.

Another common mistake is not providing a detailed response to questions that require further explanation. If a question is answered with a "Yes," it is essential to provide the requested details on the subsequent pages. This requirement is crucial for ensuring that the questionnaire is complete and comprehensive.

People sometimes overlook the necessity of printing and submitting paper copies of the questionnaire, even though the forms are fillable online. This step is mandatory, and failure to do so can lead to the rejection of the submission.

Moreover, individuals often forget to check for any unauthorized changes or alterations to the questionnaire. Making changes to the form can render it void, which may complicate the submission process significantly.

Finally, a lack of attention to the instructions regarding the use of additional pages can create confusion. Each page must be clearly marked and attached correctly, ensuring that all information is organized and easily accessible for review. Addressing these common mistakes can streamline the submission process and improve the likelihood of acceptance.

More About New York Questionnaire

  1. What is the purpose of the New York Questionnaire form?

    The New York Questionnaire form is designed to collect essential information from vendors wishing to do business with New York City. It ensures that the city adheres to its charter mandate of engaging only with responsible vendors. The form consists of two main questionnaires: the Vendor Questionnaire and the Principal Questionnaire.

  2. Who needs to complete the New York Questionnaire form?

    Any vendor that intends to conduct business with New York City must complete this form. This includes businesses of all types, whether they are large corporations, small businesses, or not-for-profit organizations. All questions must be answered fully, as incomplete submissions may lead to rejection.

  3. How do I obtain the New York Questionnaire form?

    The questionnaires can be obtained in paper format from the VENDEX Unit by calling 212-341-0933. Alternatively, vendors can download the forms directly from the New York City website at http://www.nyc.gov/vendex. It is important to note that even though the forms are fillable, they must still be printed and submitted in paper form.

  4. What are the requirements for filling out the form?

    When completing the New York Questionnaire, vendors must ensure that all fields are filled out correctly. For example, date fields should follow the format MM/DD/YYYY, and telephone numbers must match the specified formats. Additionally, all responses must be typewritten or printed in ink, and a response of “Not Applicable (N/A)” is not acceptable.

  5. What happens if I do not complete the questionnaire fully?

    Failure to submit a fully completed questionnaire may result in the rejection of the VENDEX submission. It is crucial to answer all questions thoroughly and accurately. If additional space is needed for responses, vendors should photocopy the relevant section and attach it to the questionnaire.

  6. Can I make changes to the questionnaire after submitting it?

    No, making any unauthorized changes or alterations to the questionnaire will render it void. Vendors must ensure that the information provided is accurate and complete before submission.

  7. What should I do if I have questions about the form?

    If vendors encounter any issues or have questions regarding the questionnaire, they can reach out for assistance by emailing VENDEXFEEDBACK@cityhall.nyc.gov. The support team aims to respond as promptly as possible.

  8. Is there any additional resource available for guidance on the questionnaire?

    Yes, the publication titled “Vendor’s Guide to VENDEX” provides valuable assistance and explanations regarding the questionnaires. This guide includes definitions of terms used throughout the forms. Vendors can download this publication from the New York City website or request it from the VENDEX Unit.

Misconceptions

Misconceptions about the New York Questionnaire form can lead to confusion and delays in the procurement process. Here are seven common misconceptions clarified for your understanding:

  • 1. The form can be submitted electronically. Many believe that since the form is fillable, it can be submitted electronically. However, despite being fillable, you must print and submit paper copies of the completed questionnaires.
  • 2. All fields are optional. Some think that they can skip questions that do not apply to them. In reality, all questions must be answered, and a response of “Not Applicable” is not acceptable.
  • 3. The form only requires basic information. Many vendors underestimate the amount of detail required. The questionnaire asks for comprehensive information, including financial details and business history, which are crucial for evaluation.
  • 4. You can submit a form with incomplete information. A common misconception is that partial submissions are acceptable. In fact, failing to submit a fully completed questionnaire may result in rejection of your submission.
  • 5. You can alter the questionnaire if needed. Some vendors believe they can make changes to the form for clarity or convenience. However, any unauthorized changes or alterations will render the questionnaire void.
  • 6. The form is only for large businesses. Many assume that only large vendors need to fill out this form. In truth, any vendor wishing to do business with New York City, regardless of size, must complete it.
  • 7. The information is not confidential. Some vendors think that their submitted information is public. While certain data may be disclosed, sensitive information, such as Social Security numbers, is treated with confidentiality under the law.

Understanding these misconceptions can help streamline the process and ensure compliance with New York City's procurement requirements. If you have any questions or concerns, don't hesitate to reach out for clarification.

Key takeaways

Filling out the New York Questionnaire form is an important step for vendors who wish to conduct business with New York City. Here are some key takeaways to keep in mind:

  • Fillable Forms: As of September 25, 2014, the VENDEX questionnaires are fillable, but you must still print and submit paper copies.
  • Required Forms: You need to complete the Vendor Questionnaire, Principal Questionnaire, and Certification of No Change.
  • Formatting Matters: Pay close attention to specific formatting requirements for various fields, such as dates and identification numbers.
  • Complete Responses: All questions must be answered. Responses like “Not Applicable (N/A)” are not acceptable.
  • Additional Space: If you require more space for your answers, photocopy the relevant page, check the box indicating additional information, and attach it.
  • Assistance Available: For help, you can refer to the “Vendor’s Guide to VENDEX,” which provides definitions and explanations of terms used in the questionnaires.
  • Submission Location: All completed forms should be sent to the Mayor’s Office of Contract Services at the specified address in the form.
  • Accuracy is Crucial: Carefully complete the questionnaire. Incomplete submissions may lead to rejection.
  • Unauthorized Changes: Any unauthorized alterations to the questionnaire will render it void, so ensure you follow the instructions precisely.

By keeping these points in mind, you can ensure a smoother process when filling out and submitting the New York Questionnaire form. Your diligence will contribute to a successful application to do business with the city.

New York Questionnaire: Usage Guide

Completing the New York Questionnaire form is an important step for vendors wishing to do business with the city. This process ensures that all necessary information is accurately provided, which can affect your ability to engage in contracts with New York City. Follow the steps below to fill out the form correctly.

  1. Obtain the New York Questionnaire form. You can download it from the NYC website or request a paper copy from the VENDEX Unit.
  2. Begin with the Vendor Information section. Fill in the submitting vendor's name and EIN/SSN/TIN.
  3. Indicate the type of submission by checking either the Full questionnaire or Changed questionnaire option.
  4. Provide the name and contact information of the person completing the questionnaire, including their telephone number, fax number, and email address.
  5. Complete the Submitting Vendor’s Address section. Include the principal executive office address and the primary place of business in the NYC metropolitan area.
  6. Check the appropriate boxes regarding the ownership status of the primary place of business (owned, rented, etc.).
  7. List the addresses of the three largest sites where work will occur in connection with the contract.
  8. Fill in the Annual Gross Revenue section by selecting the appropriate revenue range.
  9. Indicate the business category by checking all that apply (e.g., Professional services, Manufacturing, etc.).
  10. Provide the DUNS number if applicable, and indicate if the vendor is listed on a national or regional stock exchange.
  11. Complete the section regarding the date the submitting vendor began business in New York City.
  12. Answer the series of questions regarding the vendor's history and affiliations. Be thorough and provide detailed responses where required.
  13. If more space is needed for any response, photocopy the relevant page, check the box indicating additional information is attached, and include it with the submission.
  14. Review the entire questionnaire for accuracy. Ensure all fields are completed, as incomplete submissions may be rejected.
  15. Print the completed questionnaire. Remember, despite the form being fillable, you must submit paper copies.
  16. Send the completed form to MOCS at the specified address: 253 Broadway, 9th Floor; New York, New York 10007.
  17. If you have questions, reach out to the VENDEX Unit at 212-341-0933 for assistance.