The New York Questionnaire form is a critical document used by vendors seeking to do business with New York City. This form, part of the Vendor Information Exchange System (VENDEX), collects essential information to ensure compliance with city regulations regarding responsible vendors. Completing this form accurately is vital for successful participation in city contracts.
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The New York Questionnaire form plays a critical role in the procurement process for vendors wishing to engage in business with New York City. This form, known as the Vendor Information Exchange System (VENDEX), consists of two primary questionnaires: the Vendor Questionnaire and the Principal Questionnaire. These documents are designed to collect essential information about potential vendors, ensuring that the city adheres to its charter mandate of conducting business only with responsible entities. As of September 25, 2014, the questionnaires have been updated to be fillable, allowing for easier completion. However, vendors must still print and submit paper copies. Specific formatting guidelines are provided, such as the required formats for dates, telephone numbers, and identification numbers. Each question on the form must be answered completely, as responses that indicate "Not Applicable" will not be accepted. Additionally, vendors are encouraged to refer to the "Vendor’s Guide to VENDEX" for assistance and clarification on the questions. It is crucial to submit a fully completed questionnaire to avoid rejection, and any unauthorized changes will render the form void. The completed forms should be sent to the Mayor's Office of Contract Services, ensuring compliance with all submission requirements.
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 [email protected] 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
Completing the New York Questionnaire form requires careful attention to detail and accuracy. This form is essential for vendors wishing to do business with New York City. It collects critical information to ensure compliance with city regulations. Follow the steps below to fill out the form correctly.
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 complies with its charter mandate to engage only with responsible vendors. The form includes both the Vendor Questionnaire and the Principal Questionnaire, which gather relevant details about the vendor's operations and business practices.
The New York Questionnaire form can be obtained in paper format from the VENDEX Unit by calling 212-341-0933. Additionally, it is available for download from the New York City website at http://www.nyc.gov/vendex .
Yes, the form has specific formatting requirements for certain fields. For example:
It is important to ensure that all information is accurately inputted, even if the formatting does not match perfectly due to form limitations.
If additional space is required to answer any question, you should photocopy the relevant page of the questionnaire. After completing the photocopied page, check the box indicating that additional information is attached and include it with your submission.
Failure to submit a fully completed questionnaire may lead to the rejection of the VENDEX submission. It is crucial to answer all questions thoroughly, as responses of "Not Applicable (N/A)" are not acceptable. Any unauthorized changes or alterations to the questionnaire will render it void.
The completed New York Questionnaire form must be printed and submitted in paper format. All forms should be sent to the Mayor's Office of Contract Services (MOCS) at the following address:
253 Broadway, 9th Floor, New York, NY 10007.
If you have any questions or concerns regarding the New York Questionnaire form, you can reach out to the VENDEX Unit at 212-341-0933. Additionally, you may email inquiries to [email protected] , and they will respond as soon as possible.
Inaccurate Information: Many people mistakenly provide incorrect details, such as the EIN, SSN, or TIN. Ensure these numbers are accurate and match your official documents.
Improper Formatting: Each field has specific formatting requirements. For example, dates must be in MM/DD/YYYY format. Failing to follow these guidelines can lead to rejection.
Missing Responses: Leaving questions unanswered is a common error. Every question must be addressed, even if the answer is "Not Applicable" or similar. This could result in submission rejection.
Neglecting Attachments: If additional space is needed for answers, remember to photocopy the relevant page and attach it. Forgetting to do this can lead to incomplete submissions.
Submitting Incorrect Copies: Even though the form is fillable, it must be printed and submitted in paper format. Digital submissions are not accepted.
Ignoring Deadlines: Be aware of submission deadlines. Late submissions can result in disqualification from the bidding process.
Not Seeking Help: If there are questions about the form, many individuals fail to reach out for assistance. Contacting the VENDEX Unit can clarify uncertainties and improve the quality of your submission.
The New York Questionnaire form is an essential document for vendors looking to engage in business with New York City. To ensure a smooth submission process, several other forms and documents are often required in conjunction with this questionnaire. Below is a list of these important documents.
Understanding these accompanying documents is vital for any vendor aiming to do business with New York City. Properly completing and submitting these forms can significantly impact the approval process and the ability to secure contracts. Always ensure that each document is filled out accurately and submitted in accordance with the specified guidelines.
The Vendor Questionnaire is similar to the Small Business Administration (SBA) Form 1003, which is used for loan applications. Both documents require detailed information about the business, including ownership structure, financial information, and operational history. They aim to assess the credibility and stability of the vendor or applicant. The SBA Form 1003, like the Vendor Questionnaire, mandates that applicants provide accurate and complete information to ensure a thorough evaluation of their eligibility for funding or contracts.
Another comparable document is the IRS Form W-9, which is used to request a taxpayer identification number and certification. Both forms necessitate the disclosure of sensitive information, such as Social Security Numbers or Employer Identification Numbers. They serve the purpose of verifying the identity of the entity or individual and ensuring compliance with tax regulations. The W-9 form, similar to the Vendor Questionnaire, requires careful completion to avoid delays in processing or potential legal issues.
The Principal Questionnaire bears resemblance to the Personal Financial Statement (PFS), which is often required by lenders. Both documents collect personal and financial information about the key individuals involved in a business. They aim to assess the financial health and creditworthiness of the principals. The PFS, much like the Principal Questionnaire, requires detailed reporting of assets, liabilities, and income, ensuring that lenders have a comprehensive view of the individual's financial situation.
Additionally, the Vendor Questionnaire is akin to the Dun & Bradstreet Business Information Report. This report provides a comprehensive overview of a business's creditworthiness and operational history. Both documents are used to evaluate a vendor's reliability and financial stability. The Dun & Bradstreet report, similar to the Vendor Questionnaire, compiles data on payment history, legal filings, and financial performance, helping organizations make informed decisions about potential business partnerships.
Another similar document is the Certificate of Good Standing, which is often required in business transactions. Both the Certificate and the Vendor Questionnaire provide essential information about a business's legal status and compliance with state regulations. The Certificate of Good Standing verifies that a business is authorized to operate and is up to date with its filings, similar to how the Vendor Questionnaire ensures that vendors meet the necessary qualifications to do business with the city.
The Vendor Questionnaire also shares similarities with the Federal Acquisition Regulation (FAR) Form 1449, which is used in government contracting. Both forms require detailed information about the vendor's capabilities, experience, and financial standing. They aim to ensure that only qualified vendors are selected for government contracts. The FAR Form 1449, like the Vendor Questionnaire, emphasizes the importance of thorough and accurate information to facilitate a fair bidding process.
Moreover, the Vendor Questionnaire is comparable to the State of New York’s Affirmative Action Compliance Form. This form is designed to ensure that vendors comply with state regulations regarding equal opportunity and affirmative action. Both documents require vendors to provide information about their business practices and commitment to diversity and inclusion. The Affirmative Action Compliance Form, like the Vendor Questionnaire, plays a crucial role in promoting responsible business practices within the state.
The Vendor Questionnaire also resembles the Business License Application, which is required for businesses to operate legally within a jurisdiction. Both documents collect vital information about the business structure, ownership, and operational details. The Business License Application, like the Vendor Questionnaire, serves to ensure that businesses comply with local laws and regulations before they can engage in commercial activities.
Lastly, the Vendor Questionnaire is similar to the Conflict of Interest Disclosure Form. This form is used to identify any potential conflicts that may arise in business dealings. Both documents aim to promote transparency and accountability in business relationships. The Conflict of Interest Disclosure Form, much like the Vendor Questionnaire, requires individuals to disclose any relationships or interests that could influence their business decisions, ensuring ethical practices in vendor selection.
When completing the New York Questionnaire form, attention to detail is crucial. Here is a list of what you should and should not do to ensure your submission is accurate and complete.
By following these guidelines, you can help ensure that your submission meets all requirements and is processed smoothly.
Misconceptions about the New York Questionnaire form can lead to confusion and errors in submission. Here are four common misconceptions:
The New York Questionnaire form is essential for vendors wishing to conduct business with the City of New York. Below are key takeaways regarding its completion and submission: