Att 02 - Contractors Statement for Exempt Organization - IL.docx
DOCX document 36 KB Posted
- Attached to
- EHRM Installation of DDPO2 - Hines, IL
- Solicitation number
- 36C77626Q0210
About this file
This is a Contractor's Statement for Exempt Organization form specific to Illinois. The document serves as a certification tool for contractors to declare their status as exempt organizations under applicable federal and state tax laws. The form is designed to be completed by contractors bidding on the EHRM Installation of DDPO2 solicitation at the Department of Veterans Affairs facility in Hines, Illinois, and submitted as part of their proposal documentation. The statement allows eligible exempt organizations, such as nonprofits or other qualifying entities, to formally attest to their exempt status for contract purposes, which may impact eligibility, compliance requirements, or special considerations under the solicitation. Contractors completing this form must provide accurate organizational information and certification signatures as required by the contracting officer, ensuring compliance with federal contracting regulations and state-specific requirements applicable to Illinois-based contract opportunities.
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Text version
CONTRACTORS EXEMPT PURCHASE STATEMENT
The undersigned hereby certifies under the penalties of false statement that I am engaged in the performance of a construction contract on a project for the following named exempt agency or organization:
U.S. DEPARTMENT OF VETERANS AFFAIRS
State Full Name of Agency or Organization
5000 S 5th Ave, Hines, IL 60141 Address of Project
Contract Number
Date of Contract
That such organization holds exemption certificate Number E99858754 issued by the Illinois Department of Revenue Services.
This certificate is issued to cover all purchases of materials and supplies to be physically incorporated in and become a permanent part of the project referred to above. The exemption is allowable under the provision of Illinois 86 III. Adm. Code 130.2075(d).
Written Signature of Contractor or Sub-Contractor Date
Name of Contractor or Sub-Contractor
Address of Contractor of Sub-Contractor
File details come from the government source that posted it. Updated .