35613 RFA_Attachment_3_Tax_Compliance_Affidavit_Final.DOCX
DOCX document 34 KB Posted
- Attached to
- new expanded EVR program contract
- Solicitation number
- S-73000-00009423
- Issued by
- Marion County, Oregon
About this file
This document is a Tax Compliance Affidavit for a state government procurement opportunity issued by the State of Oregon, specifically related to Request for Application #S-73000-000094234 for an Electronic Vehicle Registration Expansion Process Partner. The affidavit requires an authorized representative of the applying organization to certify their tax compliance status, provide accurate taxpayer identification numbers, confirm they are not subject to backup withholding, and attest that the organization is not in violation of specified Oregon tax laws.
The affidavit serves as a formal declaration of tax compliance, covering federal and state tax obligations, with specific references to Oregon Revised Statutes (ORS) including Chapters 118, 314, 316, 317, 318, 320, 321, and 323. The document mandates that the affiant have full knowledge of the application and authority to submit the affidavit, and requires a notarized signature to validate the tax compliance statements. While the document does not provide specific financial details about the Electronic Vehicle Registration Expansion project, it is a critical component of the application process that demonstrates the applicant's financial integrity and adherence to state tax regulations.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 35613 Attachment 4_Disclosure Exemption Certification_Final.doc | DOC document | |
| S-73000-00009423 _Addendum 1.docx | DOCX document | |
| S-73000-00009423 _QA 1_Final.docx | DOCX document | |
| Insurance Requirements.pdf | ||
| 35613 EVR 2.0 SOW_Final.docx | DOCX document | |
| 35613 RFA_Final.docx | DOCX document | |
| 35613_EvaluationScoreMatrix_Final.xlsx | XLSX spreadsheet | |
| 35613 RFA_Attachment_A_Application Cover Sheet_Final.doc | DOC document | |
| 35613 Sample Contract_Final.docx | DOCX document | |
| 35613_ITA.docx | DOCX document |
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Text version
ATTACHMENT C – AFFIDAVIT of COMPLIANCE with TAX LAWS State of __________) ) ss:
County of ________) ____________________ (Affiant), being first duly sworn under oath, and representing [insert Name] (hereafter “Applicant”), hereby deposes and swears or affirms under penalty of perjury that:
I am an employee of the Applicant, I have knowledge of the Request for Applications (RFA)referenced herein, and I have full authority from the Applicant to submit this affidavit and accept the responsibilities stated herein.
I am aware that the Applicant has submitted an Application, dated on or about [insert date] (the “Application”), to the State of Oregon (State) in response to Request for Application #S-73000-000094234, for Electronic Vehicle Registration Expansion Process Partner and I am familiar with the contents of the RFA and Application.
The number shown on this form is Applicant's correct taxpayer identification;
Federal Tax Number: ____________ Oregon Tax Number: ____________ Applicant is not subject to backup withholding because (i) Applicant is exempt from backup withholding, (ii) Applicant has not been notified by the IRS that Applicant is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified Applicant that Applicant is no longer subject to backup withholding;
I am authorized to act on behalf of Applicant, and have authority and knowledge regarding Applicant's payment of taxes, and to the best of my knowledge, Applicant is not in violation of any Oregon tax laws, including, without limitation, those tax laws listed in ORS 305.380(4), namely ORS Chapters 118, 314, 316, 317, 318, 320, 321 and 323 and Sections 10 to 20, Chapter 533, Oregon Laws 1981, as amended by Chapter 16, Oregon Laws 1982 (first special session); the elderly rental assistance program under ORS 310.630 to 310.706; and any local taxes administered by the Oregon Department of Revenue under ORS 305.620.
Affiant’s Signature Signed and sworn to before me on ___________ (date) by ______________________ (Affiant’s name).
Notary Public for the State of _________________ My Commission Expires: ____________________ RFP #730-25995-14 Page 1 of 1Level 3 - Restricted
Level 3 - Restricted
Level 3 - Restricted
File details come from the government source that posted it. Updated .