7-03. Submittal Form- Vendor Setup Form.pdf
PDF 8 MB Posted
- Attached to
- UDOT RFP- Signal Pedestals
- Solicitation number
- UDOT260008MP
- Issued by
- Utah
About this file
The documents are a Vendor/Customer Creation/Modification form from the State of Utah and a W-9 Request for Taxpayer Identification Number and Certification form from the Internal Revenue Service. The first document is a standard state form used to establish a vendor profile in the state's accounting system, enabling payment processing for businesses seeking to work with Utah state agencies. The form requires detailed information including legal business name, tax identification number, address details, contact information, and payment preferences.
The W-9 form is a standard federal tax document used to provide a business or individual's taxpayer identification information to entities that will be making payments, which will be used for generating 1099 tax reporting. The form requires specification of the entity type (corporation, individual, partnership, etc.), taxpayer identification number, and certification of the accuracy of the provided information. Key sections include Part I for entering the Taxpayer Identification Number (TIN) and Part II for certification, which includes statements about backup withholding and FATCA reporting exemptions. The form also includes instructions for completing various sections and provides guidance on tax reporting requirements.
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Other files
| File | Type | Posted |
|---|---|---|
| 3-01. RFP Solicitation Information- Signal Pedestals.doc | DOC document | |
| 8-08. Submittal Form- USP Cost Sheet.xlsx | XLSX spreadsheet | |
| 6-07. USP Physical Evaluation Score Sheet.xlsx | XLSX spreadsheet | |
| 5-04. Submittal Form- Business Confidentiality- check fields.doc | DOC document | |
| 4-06. Submittal Form- Pedestal Mandatory Requirements.xlsx | XLSX spreadsheet | |
| 2-02. 2025 Pedestal Requirements.docx | DOCX document | |
| 1-05. Submittal Form- Attachment A- Standard Terms and Conditions- with check fields.docx | DOCX document |
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Text version
Creation
Modification
VENDOR/CUSTOMER CREATION/MODIFICATION
Note: Some features may not work when completing the form in the browser. Please download forms to a PDF before entering information. All forms are downloadable PDFs.
Vendor
Customer
No Yes
Address Information
Address 1 City, State, ZIP Address Type Payment Billing Ordering
Payment Billing Ordering
Address 2 City, State, ZIP Address Type Address 3 City, State, ZIP Address Type Payment Billing Ordering Contact
Email Primary Contact Phone Number Email for EFT Remittance, if applicable
Attestation
All of the information contained in this form is true and accurate to the best of my knowledge. I hereby certify that I am an authorized representative of the business and am acting in that authority and on behalf of the vendor listed above.
You are asked to provide this information to generate a valid profile in the State's Accounting system so agencies of the State can create payments or billing requests for your business.
Intended Uses of the Information The State of Utah will use this information to create a profile in our accounting system so payment or invoices can be made for your business.
Consequences for Refusing to Provide the Information
Failure to provide the requested information will prevent your profile from being valid and payment/invoices will not be generated resulting in loss of income or other collection methods to be used
Data Sharing
This information may be shared with other State Agencies to allow transactions to be processed. This information may be shared with financial institutions to generate payment and the IRS to record 1099 reporting
Preferred Payment Method EFT Check
TIN Type
Legal/Individual Name DBA if Applicable Does the Vendor have an Active Contract? Yes Tax Reporting
No If yes, enter a contract number
Tax ID Number (TIN) Organization Type
1099 Classification 1099 Reportable
Reason for Data Collection
Notice of Personal Information Data Collection UCA 63G-2-601(2)
The data collected by this form is part of record series VEND/CUST FINET, FINET Vend Cust Table, 30547 and 30546
Signature DateSigner Name
Agency Information
Agency Contact
Department Name
Department Number
URS Attestation
Is the vendor currently receiving retirement benefits from Utah Retirement Systems (URS)?
(UCA 49-11-12 Post Retirement Reemployment Restrictions Act)
PaymentPlus (Virtual Card)*If Selected Complete Form FI 171 tadarrington Underline tadarrington Underline tadarrington Underline tadarrington Line tadarrington Line
| Vendor Creation Modification Form FI170.pdf |
| W-9.pdf |
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