Appendix B - Tax and Regulatory Status and Clearance Statement.docx
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- Solicitation number
- 21260611111709
- Issued by
- Philadelphia County, Philadelphia City, Pennsylvania
About this file
This is an appendix document outlining tax and regulatory compliance requirements for applicants seeking contracts with the City of Philadelphia. The document serves as a mandatory clearance statement that must be completed and submitted with all proposals; failure to return the form will result in automatic disqualification from consideration. Applicants are required to provide detailed information including their business name, contact details, federal employer identification number or social security number, Philadelphia Business Income and Receipts Tax Account Number, and Commercial Activity License Number.
Applicants must certify either that they maintain all required licenses and permits and are current on all City tax obligations and regulatory compliance, or alternatively that they do not currently conduct business or maintain an economic presence in Philadelphia but will promptly take necessary steps to achieve compliance if awarded a contract. The form must be signed by an authorized representative and includes contact information for the Contracts Legislation Unit at the City of Philadelphia for applicant assistance.
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Appendix B - City of Philadelphia Tax and Regulatory Status and Clearance StatementFor assistance, contact the Contracts Legislation Unit:
T. David Williams, Jr., t.david.williams@phila.gov 215-686-3499
Drew Menten drew.menten@phila.gov 215-686-6132
CITY OF PHILADELPHIA TAX AND REGULATORY
STATUS AND CLEARANCE STATEMENT
FOR APPLICANTS
THIS IS A CONFIDENTIAL TAX DOCUMENT NOT FOR PUBLIC DISCLOSURE
This form must be completed and returned with Applicant’s proposal in order for Applicant to be eligible for award of a contract with the City. Failure to return this form will disqualify Applicant’s proposal from further consideration by the contracting department. Please provide the information requested in the table, check the appropriate certification option and sign below:
Applicant Name
Contact Name and Title
Street Address
City, State, Zip Code
Phone Number
Federal Employer Identification Number or Social Security Number:
Philadelphia Business Income and Receipts Tax Account Number (if none, state “none”)
Commercial Activity License Number (if none, state “none”)
____ I certify that the Applicant named above has all required licenses and permits and is current, or has made satisfactory arrangements with the City to become current with respect to the payment of City taxes or other indebtedness owed to the City (including, but not limited to, taxes collected by the City on behalf of the School District of Philadelphia), and is not in violation, or has made satisfactory arrangements to cure any violation, or other regulatory provisions applicable to Applicant contained in the Philadelphia Code.
___ I certify that the Applicant named above does not currently do business, or otherwise have an economic presence in Philadelphia. If Applicant is awarded a contract with the City, it promptly will take all steps necessary to bring it into compliance with the City’s tax and other regulatory requirements.
Authorized Signature Date
Print Name and Title
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