New York Questionnaire Form – Fill Out and Use This PDF

The New York Questionnaire form is a crucial document consisting of the Vendor Questionnaire and the Principal Questionnaire, designed to gather information from vendors intending to do business with New York City. Ensuring that the city conducts business only with responsible vendors, this comprehensive form requires thorough and accurate completion. For those looking to navigate the complexities of this form, a detailed guide is available, providing necessary assistance and explanations to make the submission process as clear and straightforward as possible.

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New York Questionnaire Form PDF Details

In a move to streamline the process of collecting data from vendors aiming to engage in business with New York City, the administration under Mayor Bill de Blasio and spearheaded by City Chief Procurement Officer Lisette Camilo introduced an updated version of the VENDEX questionnaires on September 25, 2014. These questionnaires now come in a fillable format though they must be completed, printed, and submitted in paper format. Comprising the Vendor and Principal Questionnaires alongside a Certification of No Change form, they serve as a critical tool for ensuring that the city only conducts business with responsibly vetted vendors, aligning with the mandate in the city’s charter. The meticulous design of these forms, while accommodating various data types, demonstrates a commitment to precision and security, particularly in handling sensitive information like social security numbers and employer identification numbers. Despite this digital shift, the insistence on paper submission underscores a cautious approach to data integrity and verification. This adaptation also reflects an ongoing pursuit of efficiency in the city’s procurement processes, while setting clear expectations for the vendor’s compliance and complete disclosure, crucial for maintaining transparency and trust in public and private sector interactions.

Question	Answer
Form Name	New York Questionnaire Form
Form Length	21 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	5 min 15 sec
Other names	vendor questionnaire page template, vendor questionnaire page, vendex information exchange system online, vendex exchange

Form Preview Example

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)

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
$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

DUNS number

none

National or regional stock exchange or NASDAQ listing

none

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

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?

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
a.	No	Yes
			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
c.	No	Yes
			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?

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
c.	No	Yes
			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?
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
9.	No		Yes
				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.

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Learn how to fill in vendor vendex portion 1

2. After performing the previous part, head on to the next part and fill out the essential details in these fields - Vendor Questionnaire Page of, Fillable, Submitting vendors EINSSNTIN, Revised, VENDOR QUESTIONNAIRE, The Vendor Information Exchange, Questionnaires may be obtained in, Questionnaires must be completed, and The publication Vendors Guide to.

vendor vendex writing process shown (part 2)

3. This next step is mostly about UTHORIZED CHANGE OR ALTERA, TERATION WILL RENDER IT VVOIDOID, QQUESTIONNAIRE, Name of submitting vendor, cid Controlling entity, cid Subcontractor, Type of submission Check one, cid Full questionnaire cid, If checked provide submission date, Name of person completing this, EmployerTitle, Telephone Number, Fax Number, Email address, and The disclosure of the social - complete each of these fields.

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5. To finish your form, the particular subsection incorporates a few additional blank fields. Filling in Vendor Questionnaire Page of, Submitting vendors EINSSNTIN, Revised, Submitting vendors Principal, StreetPO Box, CityStateZip Code, Floor Suite, Telephone Number, Fax Number, Primary place of business in the, StreetPO Box, CityStateZip Code, Floor Suite, Telephone Number, and Fax Number is going to wrap up the process and you'll be done quickly!

vendor vendex completion process clarified (part 5)

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New York Questionnaire Form – Fill Out and Use This PDF

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