Attachment 19 - Contractors Statement for Exempt Organization - Illinois.docx
DOCX document 35 KB Posted
- Attached to
- Y1DA--556-402 Expand Sterile Processing Service (SPS) - Construction - Lovell FHCC, North Chicago, IL
- Solicitation number
- 36C77624B0018
About this file
This document is a Contractors Exempt Purchase Statement for a construction contract on a project for the U.S. Department of Veterans Affairs. The contractor certifies that the project is covered under the agency's exemption certificate number E99858754 issued by the Illinois Department of Revenue Services, which allows for the purchase of materials and supplies to be physically incorporated into the project. The contract information provided includes the contract number 36C77623C0119, the contract date of 09/01/2023, and the project location of 12401 West Main Street, Marion, IL 629592.
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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
12401 West Main Street, Marion, IL 629592 Address of Project
36C77623C0119 Contract Number
09/01/2023 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 .