Certificate Of No Change Form - Nyc

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Certificate of No Change Form
Please submit two completed forms. Copies will not be accepted.
Please send both copies to the agency that requested it, unless you are advised to send it
directly to the Mayor’s Office of Contract Services (MOCS).
A materially false statement willfully or fraudulently made in connection with this certification,
and/or the failure to conduct appropriate due diligence in verifying the information that is the
subject of this certification, may result in rendering the submitting entity non-responsible for the
purpose of contract award.
A materially false statement willfully or fraudulently made in connection with this certification
may subject the person making the false statement to criminal charges
I, _____________________________________________, being duly sworn, state that I have read
Enter Your Name
and understand all the items contained in the vendor questionnaire and any submission of change
as identified on page one of this form and certify that as of this date, these items have not
changed. I further certify that, to the best of my knowledge, information and belief, those answers
are full, complete, and accurate; and that, to the best of my knowledge, information, and belief,
those answers continue to be full, complete, and accurate.
In addition, I further certify on behalf of the submitting vendor that the information contained in the
principal questionnaire(s) and any submission of change identified on page two of this form have
not changed and have been verified and continue, to the best of my knowledge, to be full, complete
and accurate.
I understand that the City of New York will rely on the information supplied in this certification as
additional inducement to enter into a contract with the submitting entity.
Vendor Questionnaire
This section is required.
This refers to the vendor questionnaire(s) submitted for the vendor doing business with the City.
Name of Submitting Entity: ________________________________________________________
Vendor’s Address: ________________________________________________________________
Vendor’s EIN or TIN: _____________________ Requesting Agency: ________________________
Are you submitting this Certification as a parent? (Please circle one)
Yes
No
Signature date on the last full vendor questionnaire signed for the submitting vendor: __________
Signature date on change submission for the submitting vendor: ___________________________
Mayor’s Office of Contract Services
1
253 Broadway, 9th Floor New York, NY 10007
Phone: 212 788 0018 Fax: 212 788 0049

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