Specifications

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ST-220-CA
(6/06)
New York State Department of Taxation and Finance
Contractor Certification to Covered Agency
(Pursuant to Section 5-a of the Tax Law, as amended, effective April 26, 2006)
For information, consult Publication 223, Question and Answers Concerning Tax Law Section 5-a (see Need Help? on back).
Contractor name
For covered agency use only Contract
number or description
Contractor’s principal place of business City State ZIP code
Contractor’s mailing address (if different than above)
Estimated contract value over the full
term of contract (but not including
renewals)
Contractor's federal employer identification number (EIN)
Contractor's sales tax ID number (if different from contractor's EIN)
$
Contractor's telephone number
( )
Covered agency name
Covered agency address
Covered agency telephone number
I, ________________________________ , hereby affirm, under penalty of perjury, that I am ______________________________
(name) (title)
of the above-named contractor, that I am authorized to make this certification on behalf of such contractor, and I further certify that:
(Mark an X in only one box)
The contractor has filed Form ST-220-TD with the Department of Taxation and Finance in connection with this contract and, to
the best of contractor’s knowledge, the information provided on the Form ST-220-TD, is correct and complete.
The contractor has previously filed Form ST-220-TD with the Tax Department in connection with
(insert contract number or description)
and, to the best of the contractor’s knowledge, the information provided on that previously filed Form T-220-TD, is correct and
complete as of the current date, and thus the contractor is not required to file a new Form ST-220-TD at this time.
Sworn to this______ day of _________, 20 ____
(sign before a notary public) (title)
Instructions
General Information
Tax Law section 5-a was amended, effective April 26, 2006. On or after that date,
in all cases where a contract is subject to Tax Law section 5-a, a contractor must
file (1) Form ST-220-CA, Contractor Certification to Covered Agency, with a
covered agency, and (2) Form ST-220-TD with the Tax Department before a
contract may take effect. The circumstances when a contract is subject to section
5-a are listed in Publication 223, Q&A 3. This publication is available on our Web
site, by fax, or by mail. (See Need help? for more information on how to obtain
this publication.) In addition, a contractor must file a new Form ST-220-CA with a
covered agency before an existing contract with such agency may be renewed.
If you have questions, please call our information center at 1 800 698-2931.
Note: Form ST-220-CA must be signed by a person authorized to make the
certification on behalf of the contractor, and the acknowledgement on page 2 of
this form must be completed before a notary public.
When to complete this form
As set forth in Publication 223, a contract is subject to section 5-a, and you must
make the required certification(s), if:
i. The procuring entity is a covered agency within the meaning of the statute
(see Publication 223, Q&A 5);
ii. The contractor is a contractor within the meaning of the statute (see
Publication 223, Q&A 6); and
iii. The contract is a contract within the meaning of the statute. This is the case
when it (a) has a value in excess of $100,000 and (b) is a contract for
commodities or services, as such terms are defined for purposes of the
statute (see Publication 223, Q&A 8 and 9).
Furthermore, the procuring entity must have begun the solicitation to purchase on
or after January 1, 2005, and the resulting contract must have been awarded,
amended, extended, renewed, or assigned on or after April 26, 2006 (the
effective date of the section 5-a amendments).