Vendor Questionnaire Form – Fill Out and Use This PDF

The Vendor Questionnaire form, specifically the AC 3290-S (Rev. 9/13) for New York State, serves as a comprehensive document designed to assess the responsibility and suitability of for-profit business entities aiming to engage in commerce or contract with the state. It demands detailed information on the business entity, including legal structure, ownership, and operation details, requiring an owner or officer's certification with notarization. This document aims to ensure transparent and responsible business operations by binding vendors to the terms defined in the "New York State Vendor Responsibility Definitions List." To streamline the evaluation process and engage in potential state-level opportunities, ensure you complete the form thoughtfully. Click the button below to start filling out your form.

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Vendor Questionnaire Form PDF Details

Navigating through the complexities of establishing a business relationship with the New York State requires thorough understanding and accurate completion of several forms, among which the Vendor Questionnaire for For-Profit Business Entity, or AC 3290-S (Rev. 9/13), stands out as a crucial one. This detailed form, designed to be filled out either in print or online via the New York State VendRep System, serves as an integral step in ensuring vendor responsibility and integrity. The process mandates that the questionnaire be completed by individuals with significant knowledge about the vendor's operations and further authenticated through the notarization of an owner or officer's signature. Incorporating a Vendor ID, a unique ten-digit identifier, it’s a prerequisite for vendors registered on the Statewide Vendor File, demanding a comprehensive understanding due to its specialized terminology — all terms underlined within the document are clearly defined in the “New York State Vendor Responsibility Definitions List”. Addressing the form requires an all-encompassing approach: every question must be meticulously answered, reflecting the vendor’s legal business entity or an organizational unit within, alongside information regarding any Associated Entities. It is structured into eleven informative sections, each demanding different layers of detail about the vendor's legal standing, organizational structure, leadership integrity, and much more, making it imperative that the form is approached with both attention and precisiveness to guarantee compliance and foster a transparent relationship with the New York State government.

Question	Answer
Form Name	Vendor Questionnaire Form
Form Length	10 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min 30 sec
Other names	vendor responsibility questionnaire look up ny, vendor questionnaire responsibility, new york state questionnaire, vendor responsibility questionnaire fillable

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AC 3290-S (Rev. 9/13)

NEW YORK STATE

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

You have selected the For-Profit Non-Construction questionnaire which may be printed and completed in this format or, for your convenience, may be completed online using the New York State VendRep System.

COMPLETION & CERTIFICATION

The person(s) completing the questionnaire must be knowledgeable about the vendor’s business and operations. An owner or officer must certify the questionnaire and the signature must be notarized.

NEW YORK STATE VENDOR IDENTIFICATION NUMBER (VENDOR ID)

The Vendor ID is a ten-digit identifier issued by New York State when the vendor is registered on the Statewide Vendor File. This number must now be included on the questionnaire. If the business entity has not obtained a Vendor ID, contact the OSC Help Desk at ciohelpdesk@osc.state.ny.us or call 866-370-4672.

DEFINITIONS

All underlined terms are defined in the “New York State Vendor Responsibility Definitions List,” found at www.osc.state.ny.us/vendrep/documents/questionnaire/definitions.pdf. These terms may not have their ordinary, common or traditional meanings. Each vendor is strongly encouraged to read the respective definitions for any and all underlined terms. By submitting this questionnaire, the vendor agrees to be bound by the terms as defined in the "New York State Vendor Responsibility Definitions List" existing at the time of certification.

RESPONSES

Every question must be answered. Each response must provide all relevant information which can be obtained within the limits of the law. However, information regarding a determination or finding made in error which was subsequently corrected is not required. Individuals and Sole Proprietors may use a Social Security Number but are encouraged to obtain and use a federal Employer Identification Number (EIN).

REPORTING ENTITY

Each vendor must indicate if the questionnaire is filed on behalf of the entire Legal Business Entity or an Organizational Unit within or operating under the authority of the Legal Business Entity and having the same EIN. Generally, the Organizational Unit option may be appropriate for a vendor that meets the definition of “Reporting Entity” but due to the size and complexity of the Legal Business Entity, is best able to provide the required information for the Organizational Unit, while providing more limited information for other parts of the Legal Business Entity and Associated Entities.

ASSOCIATED ENTITY

An Associated Entity is one that owns or controls the Reporting Entity or any entity owned or controlled by the Reporting Entity. However, the term Associated Entity does not include “sibling organizations” (i.e., entities owned or controlled by a parent company that owns or controls the Reporting Entity), unless such sibling entity has a direct relationship with or impact on the Reporting Entity.

STRUCTURE OF THE QUESTIONNAIRE

The questionnaire is organized into eleven sections. Section I is to be completed for the Legal Business Entity. Section II requires the vendor to specify the Reporting Entity for the questionnaire. Section III refers to the individuals of the Reporting Entity, while Sections IV-VIII require information about the Reporting Entity. Section IX pertains to any Associated Entities, with one question about their Officials/Owners. Section X relates to disclosure under the Freedom of Information Law (FOIL). Section XI requires an authorized contact for the questionnaire information.

AC 3290-S (Rev. 9/13)

NYS Vendor ID: ____________

NEW YORK STATE

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

I. LEGAL BUSINESS ENTITY INFORMATION

Legal Business Entity Name*		EIN

Address of the Principal Place of Business (street, city, state, zip code)		New York State Vendor Identification Number

		Telephone		Fax
			ext.

Email	Website

Additional Legal Business Entity Identities: If applicable, list any other DBA, Trade Name, Former Name, Other Identity, or EIN used in the last five (5) years and the status (active or inactive).

Type		Name		EIN	Status



1.0 Legal Business Entity Type – Check appropriate box and provide additional information:

	Corporation (including PC)		Date of Incorporation

	Limited Liability Company (LLC or PLLC)		Date of Organization

	Partnership (including LLP, LP or General)		Date of Registration or Establishment

	Sole Proprietor		How many years in business?

	Other		Date Established

If Other, explain:

1.1	Was the Legal Business Entity formed or incorporated in New York State?		Yes	No

	If ‘No,’ indicate jurisdiction where Legal Business Entity was formed or incorporated and attach a Certificate of Good Standing
	from the applicable jurisdiction or provide an explanation if a Certificate of Good Standing is not available.
	United States	State
	Other	Country

	Explain, if not available:

1.2	Is the Legal Business Entity publicly traded?		Yes	No

	If “Yes,” provide CIK Code or Ticker Symbol

1.3	Does the Legal Business Entity have a DUNS Number?		Yes	No

	If “Yes,” Enter DUNS Number

*All underlined terms are defined in the “New York State Vendor Responsibility Definitions List,” which can be found at www.osc.state.ny.us/vendrep/documents/questionnaire/definitions.pdf.

Page 2 of 10

AC 3290-S (Rev. 9/13)

NYS Vendor ID: ____________

NEW YORK STATE

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

I. LEGAL BUSINESS ENTITY INFORMATION

1.4 If the Legal Business Entity’s Principal Place of Business is not in New York State, does the Legal Business	Yes	No
Entity maintain an office in New York State?	Yes	No
Entity maintain an office in New York State?	N/A
(Select “N/A,” if Principal Place of Business is in New York State.)	N/A


If “Yes,” provide the address and telephone number for one office located in New York State.

1.5Is the Legal Business Entity a New York State certified Minority-Owned Business Enterprise (MBE), Women-Owned Business Enterprise (WBE), New York State Small Business (SB) or a federally certified Disadvantaged Business Enterprise (DBE)?

If “Yes,” check all that apply:

New York State certified Minority-Owned Business Enterprise (MBE)

New York State certified Women-Owned Business Enterprise (WBE)

New York State Small Business (SB)

Federally certified Disadvantaged Business Enterprise (DBE)

Yes

1.6Identify Officials and Principal Owners, if applicable. For each person, include name, title and percentage of ownership. Attach additional pages if necessary. If applicable, reference to relevant SEC filing(s) containing the required information is optional.

Name

Title

Percentage Ownership

(Enter 0% if not applicable)

Page 3 of 10

AC 3290-S (Rev. 9/13)

NYS Vendor ID: ____________

NEW YORK STATE

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

II. REPORTING ENTITY INFORMATION

2.0The Reporting Entity for this questionnaire is: Note: Select only one.

Legal Business Entity

Note: If selecting this option, “Reporting Entity” refers to the entire Legal Business Entity for the remainder of the questionnaire. (SKIP THE REMAINDER OF SECTION II AND PROCEED WITH SECTION III.)

Organizational Unit within and operating under the authority of the Legal Business Entity

SEE DEFINITIONS OF “REPORTING ENTITY” AND “ORGANIZATIONAL UNIT” FOR ADDITIONAL INFORMATION ON CRITERIA TO QUALIFY FOR THIS SELECTION.

Note: If selecting this option, “Reporting Entity” refers to the Organizational Unit within the Legal Business Entity for the remainder of the questionnaire. (COMPLETE THE REMAINDER OF SECTION II AND ALL REMAINING SECTIONS OF THIS QUESTIONNAIRE.)

IDENTIFYING INFORMATION

a)Reporting Entity Name

Address of the Primary Place of Business (street, city, state, zip code)

Telephone

ext.

b)Describe the relationship of the Reporting Entity to the Legal Business Entity

c)Attach an organizational chart

d) Does the Reporting Entity have a DUNS Number?	Yes	No

If “Yes,” enter DUNS Number

e)Identify the designated manager(s) responsible for the business of the Reporting Entity. For each person, include name and title. Attach additional pages if necessary.

Name

Title

Page 4 of 10

AC 3290-S (Rev. 9/13)

NYS Vendor ID: ____________

NEW YORK STATE

VENDOR RESPONSIBILITY QUESTIONNAIRE

FOR-PROFIT BUSINESS ENTITY

INSTRUCTIONS FOR SECTIONS III THROUGH VII

For each “Yes,” provide an explanation of the issue(s), relevant dates, the government entity involved, any remedial or corrective action(s) taken and the current status of the issue(s). For each “Other,” provide an explanation which provides the basis for not definitively responding “Yes” or “No.” Provide the explanation at the end of the section or attach additional sheets with numbered responses, including the Reporting Entity name at the top of any attached pages.

III. LEADERSHIP INTEGRITY

Within the past five (5) years, has any current or former reporting entity official or any individual currently or formerly having the authority to sign, execute or approve bids, proposals, contracts or supporting documentation on behalf of the reporting entity with any government entity been:

3.0	Sanctioned relative to any business or professional permit and/or license?	Yes	No	Other

3.1	Suspended, debarred, or disqualified from any government contracting process?	Yes	No	Other

3.2	The subject of an investigation, whether open or closed, by any government entity for a civil or	Yes	No	Other
	criminal violation for any business-related conduct?	Yes	No	Other
	criminal violation for any business-related conduct?

3.3	Charged with a misdemeanor or felony, indicted, granted immunity, convicted of a crime or	Yes	No	Other
	subject to a judgment for:

a)Any business-related activity; or

b)Any crime, whether or not business-related, the underlying conduct of which was related to truthfulness?

For each “Yes” or “Other” explain:

IV. INTEGRITY – CONTRACT BIDDING

Within the past five (5) years, has the reporting entity:

4.0	Been suspended or debarred from any government contracting process or been disqualified on any	Yes	No
	government procurement, permit, license, concession, franchise or lease, including, but not limited to,
	debarment for a violation of New York State Workers’ Compensation or Prevailing Wage laws or New
	York State Procurement Lobbying Law?

4.1	Been subject to a denial or revocation of a government prequalification?	Yes	No

4.2	Been denied a contract award or had a bid rejected based upon a non-responsibility finding by a	Yes	No
	government entity?

4.3	Had a low bid rejected on a government contract for failure to make good faith efforts on any Minority-	Yes	No
	Owned Business Enterprise, Women-Owned Business Enterprise or Disadvantaged Business Enterprise
	goal or statutory affirmative action requirements on a previously held contract?

4.4	Agreed to a voluntary exclusion from bidding/contracting with a government entity?	Yes	No

4.5	Initiated a request to withdraw a bid submitted to a government entity in lieu of responding to an	Yes	No
	information request or subsequent to a formal request to appear before the government entity?

	For each “Yes,” explain:

Page 5 of 10

How to Edit Vendor Questionnaire Form Online for Free

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It is straightforward to fill out the document using this detailed guide! This is what you should do:

1. You need to fill out the responsibility questionnaire correctly, thus be careful while working with the sections that contain these specific blanks:

vendor responsibility questionnaire conclusion process explained (part 1)

2. Once your current task is complete, take the next step – fill out all of these fields - Limited Liability Company LLC or, Date of Organization, Partnership including LLP LP or, Sole Proprietor, Other, If Other explain, Establishment, How many years in business, Date Established, Was the Legal Business Entity, Yes, If No indicate jurisdiction where, United States, State, and Other with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Stage number 2 for submitting vendor responsibility questionnaire

Always be extremely careful while filling out Other and Yes, because this is where most people make a few mistakes.

3. This step is usually simple - fill in all the fields in FORPROFIT BUSINESS ENTITY, I LEGAL BUSINESS ENTITY INFORMATION, If the Legal Business Entitys, Business Entity maintain an office, Select NA if Principal Place of, Yes, If Yes provide the address and, Is the Legal Business Entity a, Yes, MBE WomenOwned Business Enterprise, If Yes check all that apply, New York State certified, New York State certified, New York State certified, and New York State Small Business SB to finish this segment.

Writing section 3 of vendor responsibility questionnaire

4. This next section requires some additional information. Ensure you complete all the necessary fields - If there is no person or Business, Name of Officials and Principal, Title, Name of each Business Entity, Address, Date of Birth, Percentage Ownership Enter if not, EIN, and Percentage Ownership - to proceed further in your process!

The right way to prepare vendor responsibility questionnaire portion 4

5. As you draw near to the conclusion of your document, you'll notice a few extra things to do. Mainly, Page of should all be filled out.

Tips on how to complete vendor responsibility questionnaire part 5

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