A standard vendor responsibility questionnaire is issued by the state government and contains questions pertaining to a vendor’s business as well as operations. The objective of a standard vendor responsibility questionnaire is to find out if a vendor is following certain codes as per the state vendor responsibility definitions, as mentioned in the associate’s entities chapters, sections containing reporting entity, etc.

Sample Standard Vendor Responsibility Questionnaire:

Name of the Vendor: _____________________________

Name of legal business entity: _____________________________

Employer Identification Number (EIN): ______________________________

Address (principal business):______________________________________________

City: _____________  State: __________________ Zip: ______________________

Email: _____________________________

Phone Number: ________________________ Fax: ________________________

  • What type of legal business entity do you own? Please provide date when business entity was established.

a)      Corporation      | Date of Incorporation:___________

b)      Limited Liability Organization    | Date of organization: ______________

c)      Partnership      | Date of registration: ____________

d)     Sole Proprietorship   | Years in business: __________

e)      Others:_______________ | Date established: ___________________

  • Which state was the legal business entity registered or established?

State: _______________________  City: ______________________

  • Is your legal business entity involved in public trading?

a)      Yes

b)      No

  • Does your legal business entity have a DUNS number provided by Dun & Bradstreet (D&B)? If yes, then please provide the number.

a)      Yes

b)      No

c)      DUNS Number:__________________

  • Which of the following is true for your legal business entity?

a)      State Certified Minority owned business enterprise

b)      State Certified Women owned business enterprise

c)      State Certified Small business

d)     Federal Certified Disadvantaged business enterprise

  • Has your legal business ever been disqualified, debarred or suspended from any government contract process? If “yes” then please mention date and reason.

a)      Yes

b)      No

c)      Reason:______________

d)     Date: ____/____/_____