9 Affidavit of No Change.pdf
PDF 163 KB Posted
- Solicitation number
- 2138980
- Issued by
- Albany County, Albany City, 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 for use in vendor responsibility certification. The form is designed for businesses that have previously submitted a Standard Vendor Responsibility Questionnaire (SVRQ) to NYSDOT or another State Agency within six months prior to submitting a bid or entering into a contract, subcontract, or supplemental agreement. The affidavit requires an owner or officer of the bidding entity to certify under oath that no material changes have occurred in the information provided on the previously submitted SVRQ, with space provided to document any exceptions to this certification. The form requires the affiant's signature, title, date, and notarization, along with the vendor's Federal Employer Identification Number (FEIN) and New York Vendor ID Number.
This affidavit template is applicable to the NYSDOT Road Salt – Strategic Reserves solicitation (BA26-017) covering Regions 1, 3, 5, 7, and 9, wherein qualified bidders must have reserves physically available by January 1, 2027, with all deliveries completed by March 31, 2027. The use of the Affidavit of No Change streamlines the vendor responsibility qualification process by allowing previously vetted vendors to reaffirm their compliance status without submitting a complete new questionnaire, provided their circumstances remain materially unchanged since their last submission.
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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: |
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