On October 31, every business in the five boroughs of New York City must fill out a Vendex NYC Form. This short form is designed to provide the city's Department of Small Business Services with key information about your company, including its size, ownership structure, and industry classification. Completing and submitting this form is mandatory for all businesses operating in New York City, so it's important to understand what information is required and how to submit it correctly. In this blog post, we'll walk you through the basics of Vendex NYC Form and provide some tips on completing it accurately.
We have gathered some technical information regarding the vendex nyc. There, you'll get the information about the PDF you intend to fill out, like the approximate time to complete it and other particulars.
Question | Answer |
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Form Name | Vendex Nyc |
Form Length | 8 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 2 min |
Other names | nyc dept of education health screening questionnaire pdf, new york city questionnaire, new york city vendex, vendex nyc |
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:
•EIN/TIN/SSN fields require 9 digits and no dashes
•SSN only fields require entries to match
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%
Principal Questionnair |
Fillable 9/25/14 |
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Revised 9/25/14 |
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Page 1 of 7 |
Principal’s SSN |
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PRINCIPAL 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
Questionnaires must be completed in paper format. All questions must be answered. Aresponse 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
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
Type of submission: (Check one)
1.Full questionnaire
2.Changed questionnaire
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Name of person completing this principal questionnaire |
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Employer/Title |
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Email address |
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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
Provide a detailed response for all questions answered with information and/or “YES” in the question’s corresponding section starting on page four of this questionnaire.
Principal Questionnaire |
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Revised 9/25/14 |
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Principal’s SSN |
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1. Principal owner or officer’s name |
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Date of birth |
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Home address |
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Street/P.O. Box/Apt Number |
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Floor #/Suite # |
City/State/Zip Code
Primary place of business address
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Floor #/Suite # |
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Business telephone ( |
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Business email address |
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2. State all positions (with dates) held with submitting vendor during the past five (5) years
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Title of position held: |
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3) |
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Check if more than three (3) positions were held, and attach list of titles and dates held |
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3. |
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No |
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Do you hold a ten (10) percent or greater ownership interest in the |
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submitting vendor? |
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4. |
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No |
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Are there any outstanding loans, guarantees or any other form of security |
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or lease or any other type of contribution made in whole or in part between |
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you and the submitting vendor? |
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5. |
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No |
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Within the past three (3) years, have you been a principal owner or officer |
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of any entity other than the submitting vendor? |
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No |
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Has New York City awarded any contracts to an entity listed in response |
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to Question 5 while you were a principal owner or officer? |
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Provide a detailed response for all questions answered with information and/or “YES” in the question’s corresponding section starting on page four of this questionnaire.
Principal Questionnaire |
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Revised 9/25/14 |
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Page 3 of 7 |
Principal’s SSN |
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7.At any time during the past five (5) years, have you, and/or any entity in which you have been a principal owner or officer, been subject to any of the following actions, whether pending or completed:
a..No Yes debarred from bidding on any government contract?
b.No Yes found
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Yes declared in default and/or terminated for cause on any contract, and/or had |
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any contract canceled for cause? |
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d.
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No Yes determined to be ineligible to bid or propose on any contract?
No Yes suspended from bidding on any government contract?
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Yes received an overall unsatisfactory performance rating from any government |
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agency on any contract or agreement? |
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8. Do you presently serve, or have you within the past five (5) years served, as:
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an elected or appointed official or officer? |
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b. |
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a full or |
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any New York City agency? |
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c. |
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an officer of any political party organization in New York City, whether paid or |
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unpaid? |
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d. |
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as a consultant or advisor to a New York City agency that is or was involved |
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in the solicitation, negotiation, operation and/or administration of contracts on |
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which the submitting vendor will work during this three year VENDEX cycle? |
9. During the past five (5) years, have you failed to:
a.No Yes file any applicable federal, state or New York City tax returns?
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Yes pay any applicable federal, state or New York City taxes or other assessed |
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New York City charges, including but not limited to water and sewer charges? |
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Provide a detailed response for all questions answered with information and/or “YES” in the question’s corresponding section starting on page four of this questionnaire.
Principal Questionnaire |
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Revised 9/25/14 |
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Page 4 of 7 |
Principal’s SSN |
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Provide details to questions answered “yes” in the corresponding section below.
Corresponds to Question 3. |
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Total percentage of stock owned: |
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Purchase date: |
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(if sole proprietorship, |
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enter 100%) |
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Corresponds to Question 4. (check all that apply) |
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Loan amount |
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Lease amount |
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Guarantee amount |
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Other |
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Security amount |
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Other |
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Corresponds to Question 5.
Name of entity of which you are/were a principal owner or officer
Address
EIN/TIN |
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Telephone number ( |
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Your title |
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Associated from |
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Still serving |
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Check if attaching additional information
Corresponds to Question 6.
Name of entity that received the contract
EIN/TIN
Check if attaching additional information
Provide a detailed response to all questions checked “YES” from pages one - three. If you need more space to respond, photocopy the corresponding section’s page, check the box that additional information is attached, and attach the photocopied page to this Questionnaire.
Principal Questionnaire |
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Revised 9/25/14 |
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Page 5 of 7 |
Principal’s SSN |
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Corresponds to Question 7. (Use this box for only one action. For each additional action, photocopy this page, complete the information and attach to this questionnaire.)
The following refers to section: |
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7d |
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7e |
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7f |
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Action applies to:
You (as principal owner or officer)
Entity. If checked, name
Entity’s EIN/TIN
Your title (as principal owner or officer) (while action was underway)
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Action is: |
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Pending |
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Completed |
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Date of action |
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Still ongoing |
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Name of agency initiating action |
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Contract number |
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Reason for action |
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Check if attaching additional information |
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Corresponds to Question 8. (check all that apply) |
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8a. |
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elected official |
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elected officer |
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appointed official |
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Name of agency where you serve(d) |
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Date started |
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Date completed |
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Still Serving |
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Check if attaching additional information |
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8b. |
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Full time employee |
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Part time employee |
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Consultant to NYC agency |
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Name of agency where you work(ed) |
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Date started |
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Date completed |
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Still Serving |
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Check if attaching additional information |
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8c. |
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paid officer |
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unpaid officer |
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Name of political party or organization |
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Date started |
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Date completed |
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Still Serving |
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Check if attaching additional information |
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8d. |
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Individual serves/served New York City agency as |
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consultant |
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advisor |
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Employee/advisor’s name |
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SSN |
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Date of Birth |
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Name of NYC agency |
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Check if attaching additional information |
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Provide a detailed response to all questions checked “YES” from pages one - three. If you need more space to respond, photocopy the corresponding section’s page, check the box that additional information is attached, and attach the photocopied page to this Questionnaire.
Principal Questionnaire |
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Revised 9/25/14 |
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Page 6 of 7 |
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Principal’s SSN |
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Corresponds to Question 9. |
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9a. |
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You failed to file |
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Federal taxes |
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State taxes |
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N.Y. City taxes |
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Other |
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If “State” is checked, and other than N.Y., name State |
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If “Other“ is checked, specify |
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Taxes were not filed for tax years: |
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20 |
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20 |
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20 |
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Check if attaching additional information |
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9b. |
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You failed to pay: |
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Federal taxes |
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State taxes |
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N.Y. City taxes |
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Other NYC charge |
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If “State” is checked, and other than N.Y., name State |
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If “Other NYC charge(s)” is checked, specify |
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Taxes were not paid for tax years: |
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Provide a detailed response to all questions checked “YES” from pages one - three. If you need more space to respond, photocopy the corresponding section’s page, check the box that additional information is attached, and attach the photocopied page to this Questionnaire.
Principal Questionnaire |
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Revised 9/25/14 |
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Page 7 of 7 |
Principal’s SSN |
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CERTIFICATION
THE PRINCIPAL QUESTIONNAIRE MUST BE CERTIFIED BYTHE PRINCIPAL COMPLETINGTHE QUESTIONNAIRE. A MATERIALLY FALSE STATEMENT WILLFULLY OR FRAUDULENTLY MADE IN CONNECTION WITH THIS QUESTIONNAIRE MAY RESULT IN RENDERING THE SUBMITTING VENDOR
I, |
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Name |
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Title |
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Submitting Vendor’s Name |
being duly sworn, certify that:
•I have not altered the substance of this questionnaire in any manner;
•I have read and understand all of the items contained in the foregoing 6 pages of this
questionnaire and the following |
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pages of attachments; |
•I supplied full and complete responses to each item therein to the best of my knowledge, information and belief;
•I understand that New York City will rely on the information supplied in this questionnaire as an inducement to enter into a contract with the submitting vendor;
•I understand that at the time of execution of any contract with New York City, the submitting vendor will be required to certify that the information I have supplied remains accurate, and I further understand that I may provide to the VENDEX unit, in writing, any change(s) in the information provided in this questionnaire at the time of any change in the circumstances;
•I have read the vendor questionnaire submitted by the submitting vendor, and the answers thereto, and that, to the best of my knowledge, information and belief, those answers are full, complete and accurate.
Sworn to before me this |
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, 20 |
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Notary Public
Print name
Signature
/ /
Date