9 Affidavit of No Change.pdf

PDF 163 KB Posted

Attached to
Standby Towing Operations & On-Call Towing Operations, Regions 2, 7, and 8
Solicitation number
2138674
Issued by
Essex County, New York

About this file

This is an Affidavit of No Change form issued by the New York State Department of Transportation (NYSDOT) Administrative Services Division - Purchasing Unit. The affidavit is used by vendors, contractors, or bidders who previously submitted a Standard Vendor Responsibility Questionnaire (SVRQ) to NYSDOT or another state agency within six months prior to submitting a new bid or contract. The form requires the owner or officer of the bidding entity to certify under oath that no material changes have occurred in the vendor responsibility information contained in the previously submitted SVRQ, except as specifically noted on the form. The affidavit must be accompanied by an accurate and true copy of the previously submitted SVRQ and requires notarization.

The form requires completion of identifying information including the vendor's Federal Employer Identification Number (FEIN) and New York Vendor ID Number, as well as the contract or procurement number associated with the current bid or contract opportunity. The affidavit must be signed and dated by an owner or officer of the bidding entity and notarized. This document serves as a vendor responsibility verification mechanism to streamline the procurement process by allowing vendors with recently certified questionnaires to avoid resubmitting complete vendor responsibility documentation, provided no material changes have occurred in their business circumstances, ownership structure, financial condition, or other relevant factors.

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Text version

Administrative Services Division - Purchasing Unit

NEW YORK STATE DEPARTMENT of TRANSPORTATION

Vendor Responsibility Questionnaire

AFFIDAVIT OF NO CHANGE

FEDERAL EMPLOYER IDENTIFICATION No. (FEIN): ______________________________________________

NY VENDOR ID No.: _______________________________________________________

The undersigned, being duly sworn, deposes and says:

1. I am an owner/officer of

(hereafter “bidder” or “contractor”), which is hereby tendering a bid (or anticipating a contract, subcontract, or supplemental agreement) on a New York State Department of Transportation (NYSDOT) Purchase or

Contract;

2. Bidder/Contractor previously submitted a Standard Vendor Responsibility Questionnaire (SVRQ) within six months immediately preceding the date hereof to NYSDOT (or other State Agency);

3. Attached is an accurate and true copy of such previously submitted SVRQ; and

4. I hereby certify that there has been no material change in the information pertaining to the Bidder/Contractor specified on such attached SVRQ, except as follows (enter NONE if no changes):

PRINTED OR TYPED COPY OF SIGNATURE

SIGNATURE OF OWNER/OFFICER DATE

TITLE of OWNER/OFFICER

Sworn to me this ________ day of ___________________________ , 20 ______

_________________________________________ NOTARY PUBLIC SEAL_____________________

Contract/Procurement

FEDERAL EMPLOYER IDENTIFICATION No FEIN:
NY VENDOR ID No:
hereafter bidder or contractor which is hereby tendering a bid or anticipating a contract subcontract:
specified on such attached SVRQ except as follows enter NONE if no changes 1:
specified on such attached SVRQ except as follows enter NONE if no changes 2:
specified on such attached SVRQ except as follows enter NONE if no changes 3:
DATE:
TITLE of OWNEROFFICER:
Sworn to me this:
day of:
NOTARY PUBLIC:
20:
SEAL:
Contract/Procurement #:
Printed or Typed Copy of Signature:

File details come from the government source that posted it. Updated .