Doing Business Data Form - Affordable Housing Transactions

en-USEntities participating in affordable housing transactions with the City of New York must complete a Doing Business Data Form (see Q&A sheet for more information). en-USPlease either type responses directly into this 037llable form or print answers by hand in black ink, and be sure to 037ll out the certi037cation box on the last page. en-USSubmission en-USof a complete and accurate form is required for any entity to enter into an affordablehousing transaction.en-USThis Data Form requires information to be provided on principal of037cers, owners and senior managers. The name, employer and title of each person identi037ed on the en-USData Form will be included in a public database of people who do business with the City of New York, as will the organizations that own 10% or more of the enitity. No en-USother information reported on this form will be disclosed to the public. en-USThis Data Form is not related to the City's PASSPort registration or VENDEX requirements.en-USPlease return the completed Data Form to the City of037ce that supplied it.en-US Please contact the Doing Business Accountability Project aten-US en-USDoingBusiness@mocs.nyc.goven-US or 212-788-8104 with any questions regarding this Data Form. Thank you for your cooperation.en-USIf you are completing this form by hand, en-USplease print clearly. en-USTo be completed by the City agency prior to distribution þ Agency þ en-US Transaction ID þ en-USCheck One þ en-USTransaction Type (check one)en-US Solicitation þ en-US Award þ en-USen-US Dispostition en-US(en-USDen-US) þ en-USen-US Loan/Grant en-US(en-USLen-US) þ en-USen-US Discretionary Approval en-US(en-USAen-US) þ en-USen-US Inclusionary Housing en-US(en-USIen-US) þ en-USen-US Tax Bene037t en-US(en-USBen-US) þ en-USen-US Tax Credit en-US(en-USCen-US) Entity is a Non-Pro037t þ en-US Yes þ en-USen-US Noen-USEntity Type þ en-US Corporation (any type) þ en-US Joint Venture þ en-US LLC þ en-US Partnership (any type) þ en-US Sole Proprietor þ en-USen-US Other (specify) þ en-USAddress þen-USCity þ en-US State þ en-US Zip þ en-USPhone þ en-US E-mail þ en-USProvide your e-mail address in order to receive notices regarding this form by e-mail. en-USEntity Informationen-USEntity EIN/TIN þ en-US Entity Name þ Filing Status þ (Select One) en-USen-US Entity has never completed a Doing Business Data Form. Fill out the entire form.en-US þ Change from previous Data Form dated þ en-US. en-USFill out only those sections that have en-USchanged, and indicate the name of the persons who no longer hold positions with the entity.en-USen-US No Change from previous Data Form dated þ en-US. en-USSkip to the bottom of the last page. en-USPrincipal Of037cersen-USPlease 037ll in the required identi037cation information for each of037cer listed below. If the entity has no such of037cer or its equivalent, please check "This position does not en-USexist." If the entity is 037ling a Change Form and the person listed is replacing someone who was previously disclosed, please check "This person replaced..." and 037ll in the en-USname of the person being replaced so his/her name can be removed from the en-USDoing Business Database,en-US and indicate the date that the change became effective.en-USChief Executive Of037cer (CEO) or equivalent of037cer þ þ en-USen-US This position does not existen-US en-USThe highest ranking of037cer or manager, such as the President, Executive Director, Sole Proprietor or Chairperson of the Board.en-USFirst Name þ en-US MI þ en-US Last þ en-US Birth Date (mm/dd/yy) þ en-USOf037ce Title þ en-US Employer (if not employed by entity) þ enþ en-USen-US This person replaced former CEO þ en-US on date þ en-USChief Financial Of037cer (CFO) or equivalent of037cer þ þ en-USen-US This position does not existen-US en-USThe highest ranking 037nancial of037cer, such as the Treasurer, Comptroller, Financial Director or VP for Finance.en-USFirst Name þ en-US MI þ en-US Last þ en-US en-USBirth Date (mm/dd/yy) þ en-USOf037ce Title þ en-US Employer (if not employed by entity) þ en en-USHome Address þ en-USen-US This person replaced former CFO þ en-US on date þ en-USChief Operating Of037cer (COO) or equivalent of037cer þ þ en-USen-US This position does not existen-US en-USThe highest ranking operational of037cer, such as the Chief Planning Of037cer, Director of Operations or VP for Operations.en-USFirst Name þen-US MI þ en-US Last þ en-US en-USBirth Date (mm/dd/yy) þ en-USOen-USf037ce Title þ en-US Employer (if not employed by entity) þ en en-USHome Address þ en-USen-US This person replaced former COO þ en-US on date þ en-USNEW:en-US Data Forms submitted now must include theen-US en-USlisting of en-USorganizations,en-US as well as individuals, with 10% en-USor more ownership of the entity. Until such certi037cation en-USof ownership is submitted through a change, new or en-USupdate form, a no change form will not be accepted. 1/2018 þ en-USFor information or assistance, please contact the Doing Business Accountability Project at DoingBusiness@mocs.nyc.gov or 212-788-8104.en-USDoing Business Data Formen-US en-USAffordable Housing Transactions American LegalNet, Inc. www.FormsWorkFlow.com en-USPrincipal Ownersen-USPlease 037ll in the required identi037cation information for all individuals or organizations that, through stock shares, partnership agreements or other means, en-USown or control en-US10% or more of the entity.en-US If no individual or organization owners exist, please check the appropriate box to indicate why and skip to the en-USSenior Managersen-US section.en-US en-USIf the entity is owned by other companies that control 10% or more of the entity, those companies must be listed. If an owner was identi037ed on the previous page,en-US en-US037ll in his/her name and write "See above." If the entity is 037ling a Change Form, list any individuals or organizations that are no longer owners at the bottom of this section.en-US en-USIf more space is needed, attach additional pages labeled "Additional Owners."en-USThere are no owners listed because (select one):en-US The entity is not-for-pro037t þ en-US The entity is an individual þ en-USen-US No individual or organization owns 10% or more of the entityen-USOther (explain) þ en-USIndividual Owners (who own or control 10% or more of the entity)en-USFirst Name þ en-US MI þ en-US Last þ en-US Birth Date (mm/dd/yy) þ en-USOf037ce Title þ en-US Employer (if not employed by entity) þ en en-USHome Address þ en-USFirst Name þ en-US MI þ en-US Last þ en-US Birth Date (mm/dd/yy) þ en-USOf037ce Title þ en-US Employer (if not employed by entity) þ en en-USHome Address þ þ en-USOrganization Owners (that own or control 10% or more of the entity)en-USOrganization Name þ en-USOrganization Name þ en-USOrganization Name þ en-USRemove the following previously-reported Principal Ownersen-USName þ en-US Removal Date þ en-USName þ en-US Removal Date þ en-USName þ en-US Removal Date þ en-USSenior Managersen-USPlease 037ll in the required identi037cation information for all senior managers who oversee any of the entity's affordable housing transactions with the City. Senior managersen-US en-USinclude anyone who, either by title or duties, has substantial discretion and high-level oversight regarding the solicitation, letting or administration of any affordable en-UShousing transaction with the City. At least one senior manager must be listed, or the Data Form will be considered incomplete. If a senior manager has been identi037ed on en-USa previous page, 037ll in his/her name and write "See above." If the entity is 037ling a Change Form, list individuals who are no longer senior managers at the bottom of this en-USsection. If more space is needed, attach additional pages labeled "Additional Senior Managers."en-USSenior Managersen-USFirst Name þ en-US MI þ en-US Last þ en-US Birth Date (mm/dd/yy) þ en-USOf037ce Title þ en-US Employer (if not employed by entity) þ en en-USHome Address þ en-USFirst Name þ en-US MI þ en-US Last þ en-US Birth Date (mm/dd/yy) þ en-USOf037ce Title þ en-US Employer (if not employed by entity) þ en en-USHome Address þ þ en-USFirst Name þ en-US MI þ en-US Last þ en-US Birth Date (mm/dd/yy) þ