The New York Questionnaire form is a crucial document used by vendors wishing to conduct business with New York City. This form collects essential information to ensure compliance with the city's regulations and to verify that vendors meet the necessary standards of responsibility. Completing the form accurately is vital, as any omissions or inaccuracies could lead to rejection of the submission.
The New York Questionnaire form plays a crucial role in the vendor selection process for businesses looking to engage with New York City. This form, which includes both the Vendor Questionnaire and the Principal Questionnaire, is designed to gather essential information from vendors to ensure compliance with the city's standards for responsible business practices. Effective as of September 25, 2014, these questionnaires are now fillable online, but vendors must still print and submit paper copies. The form requires precise information entry, including specific formats for dates and identification numbers. Incomplete submissions or unauthorized changes can lead to rejection, emphasizing the importance of thoroughness. Vendors must answer every question, as responses like “Not Applicable” are not acceptable. The form also requests details about the submitting vendor’s business structure, revenue, and affiliations, among other critical data points. For assistance, vendors can refer to the “Vendor’s Guide to VENDEX,” which provides helpful explanations and definitions. Questions or concerns can be directed to the VENDEX Unit, ensuring that vendors have the support they need throughout the process.
This is not true. Even though the form is fillable, you still need to print it out and submit paper copies. This requirement is crucial for compliance.
While it’s important to provide complete information, not all fields require the same type of entry. For instance, date fields must be in MM/DD/YYYY format, and telephone numbers need to follow specific formats. Be sure to check the requirements for each field.
This is incorrect. Every question must be answered. Responses like “Not Applicable (N/A)” will not be accepted. If you need more space for your answers, you can photocopy the relevant page and attach it to your submission.
Once submitted, any unauthorized changes or alterations will void the questionnaire. It’s essential to answer everything carefully and completely before submission to avoid issues.
When filling out the New York Questionnaire form, there are several important dos and don’ts to keep in mind. Here’s a list to guide you:
The New York Questionnaire form serves as a vital tool for vendors looking to engage in business with the city. Several other documents share similarities in purpose and structure. Here are ten such documents:
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
Page 2 of 20
1.Submitting vendor’s:
a.Principal executive office address
Street/P.O. Box
Floor #/Suite #
City/State/Zip Code
b.Primary place of business (in the NYC metropolitan area)
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)
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
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.
Page 3 of 20
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.
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.
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?
Page 4 of 20
5.
a.
Does the submitting vendor share office space, staff, equipment, or
expenses with any other entities?
b.
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.
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.
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?
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:
an elected or appointed public official or officer?
a full or part-time employee in a New York City agency or as a
consultant to any New York City agency?
an officer of any political party organization in New York City, whether
paid or unpaid?
d.
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.
Does the submitting vendor control one or more entities?
9.
Does the submitting vendor have one or more affiliates, and/or is it a
subsidiary of, and controlled by any other entity?
Page 5 of 20
10.
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:
debarred from entering into any government contract?
found non-responsible on any government contract?
declared in default and/or terminated for cause?
determined to be ineligible to bid or propose on any contract?
e.
suspended from bidding or entering into any government contract?
f.
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:
at any time within the past five (5) years?
that remain open, unsatisfied, or in effect today?
13.
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:
had any permit, license, concession, franchise or lease terminated for
cause or revoked?
been disqualified for cause as a bidder on any permit, license,
concession, franchise or lease?
15.
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?
Page 6 of 20
16.Has the submitting vendor, any affiliate, or any of their current or former principal owners or officers or managerial employees:
been convicted of a misdemeanor and/or found in violation of any
administrative, statutory, or regulatory provisions in the past five (5)
years?
been convicted of a felony, and/or any crime related to truthfulness
and/or business conduct in the past ten (10) years?
have any felony, misdemeanor and/or administrative charges currently
pending?
17.
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.
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
19.
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:
file any applicable federal, state or New York City tax returns?
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.
Page 7 of 20
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
1d. Submitting vendor’s largest sites
Telephone 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
Corresponds to Question 3.
Other business addresses and telephone numbers in the last five (5) years
(Check One)
Current
Former
Main telephone number (
Main fax number (
Corresponds to Question 4. (check all that apply)
Certificate of incorporation Other, please identify
DBA
County
Date
Page 8 of 20
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
5b. Address
Additional addresses to be used not yet known
5c. Ownership interest is
principal owner
officer
immediate family
Name of party with ownership interest
Name of entity holding title or lease
Corresponds to Question 6.
6a.
Principal owner’s name
EIN/SSN
Date of birth
Percent of ownership
individual
partnership
joint venture
corporation
Page 9 of 20
Question 6 continued.
Officer’s name
cont. SSN
Title
SSN
6b.
Individual
Entity
Name
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?
If no, list address
6c.
(Check all that apply)
Stock
Ownership:
Used Loan
Pledged as collateral Obligation
Name of receiving individual and/or entity ___________________________________
Transaction date
The New York Questionnaire form is a document that vendors must complete to do business with New York City. It includes two main parts: the Vendor Questionnaire and the Principal Questionnaire. These forms collect essential information to ensure that the city engages only with responsible vendors.
You can obtain the New York Questionnaire form in paper format from the VENDEX Unit by calling 212-341-0933. Alternatively, you can download the form from the NYC website at http://www.nyc.gov/vendex .
Yes, the questionnaires are now fillable as of September 25, 2014. However, you must still print and submit the paper copies once completed.
If you have questions or concerns while filling out the form, please reach out via email at VENDEXFEEDBACK@cityhall.nyc.gov . The team will respond to your inquiry as soon as possible.
Failure to submit a fully completed questionnaire may result in the rejection of your VENDEX submission. Additionally, any unauthorized changes or alterations to the questionnaire will render it void.
You must provide various details, including:
All questions must be answered; a response of "Not Applicable (N/A)" is not acceptable.
Ensure that your entries match the required formats for specific fields. For example:
All completed forms must be sent to the Mayor's Office of Contract Services (MOCS) at 253 Broadway, 9th Floor, New York, NY 10007.
If you require additional space for your responses, photocopy the relevant page, check the box indicating that additional information is attached, and include the photocopied page with your submission.
Filling out the New York Questionnaire form is an essential step for vendors wishing to do business with New York City. The process requires attention to detail and accuracy to ensure that your submission is complete. Below are the steps to guide you through filling out the form.
After submitting the form, be sure to keep a copy for your records. If you have any questions or need assistance, contact the VENDEX Unit at the provided phone number or email address. Completing this process accurately will help facilitate your business dealings with New York City.
Filling out the New York Questionnaire form can be a daunting task. Many individuals make common mistakes that can lead to delays or rejection of their submissions. One frequent error is failing to provide complete answers to all questions. Every question must be answered, even if that means indicating "Not Applicable" where appropriate. Omitting answers can result in the rejection of the entire questionnaire.
Another common mistake involves incorrect formatting of information. For instance, date fields must follow the MM/DD/YYYY format, while telephone numbers should adhere to the XXX-XXX-XXXX or (XXX) XXX-XXXX formats. Submitting information in the wrong format can lead to confusion and processing delays.
People often overlook the requirement for specific numeric entries. For example, the Employer Identification Number (EIN), Tax Identification Number (TIN), and Social Security Number (SSN) must be nine digits long and should not include dashes. Providing incorrect numeric formats can invalidate the submission and necessitate resubmission.
Additionally, many individuals neglect to sign and date the form. A signature is essential to validate the information provided and to confirm that the questionnaire has been completed by the authorized individual. Without a signature, the submission may be considered incomplete.
Another mistake is not attaching necessary supplemental information. If additional space is needed to answer questions, individuals should photocopy the relevant page, check the box indicating that additional information is attached, and include it with the questionnaire. Failing to do so can lead to incomplete submissions.
Finally, individuals sometimes forget to print and submit the paper copies of the questionnaire, despite the form being fillable online. Even if the form is completed digitally, it must still be printed and sent in physical form to the appropriate office. Ignoring this step can result in significant delays in processing the application.
When filling out the New York Questionnaire form, it is essential to keep several key points in mind to ensure a smooth submission process.
By keeping these takeaways in mind, you can navigate the process of filling out and submitting the New York Questionnaire more effectively.
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