ATTACHMENT 5 Affidavit of Compliance with Tax Laws.pdf
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- Attached to
- ITB for Janitorial Services Canyon City
- Solicitation number
- S-47100-00013511
- Issued by
- Gilliam County, Canyonville City, Oregon
About this file
This document is an Affidavit of Compliance with Tax Laws for Invitation to Bid (ITB) S-47100-00013511 for Canyon City Janitorial services. The form requires a bidder to provide an authorized representative's attestation regarding tax identification, backup withholding status, and compliance with Oregon tax laws.
The affidavit specifically requires the bidder to confirm their federal tax number or social security number, certify they are not subject to backup withholding, and affirm that they are not in violation of any Oregon tax laws. The document lists multiple specific Oregon Revised Statutes (ORS) chapters and sections related to tax compliance, including chapters covering income tax, corporate tax, and various reporting requirements. The form must be signed by an authorized representative, notarized, and includes spaces for the state, county, date, and notary public details.
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Text version
ITB S-47100-00013511 – Canyon City Janitorial
Page 50/55
ATTACHMENT 5
AFFIDAVIT OF COMPLIANCE WITH TAX LAWS
State of ________________ ss County of ______________
____________________________________ (Affiant), on behalf of _____________________________ (hereafter “Bidder”), hereby attests under penalty of perjury that:
1. I am an authorized representative of the Bidder, and I have full authority from the Bidder to submit this affidavit and accept the responsibilities stated herein.
2. I am aware that the Bidder has submitted a bid, and I am familiar with the contents of the Invitation to Bid and the bid.
3. The number shown below is Bidder's correct taxpayer identification. (Provide one of the following identification numbers):
a. Federal Tax Number: __________________
b. Social Security Number: ________________
4. Bidder is not subject to backup withholding because (a) Bidder is exempt from backup withholding,
(b) Bidder has not been notified by the IRS that Bidder is subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified Bidder that Bidder is no longer subject to backup withholding.
5. I have knowledge regarding Bidder's payment of taxes, and to the best of my knowledge, Bidder 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, 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; and Application of penalties, misdemeanors and jeopardy assessment; employer as taxpayer under ORS 316.212, Tax on centrally assessed, mercantile, manufacturing and business corporations and financial institutions under ORS 317.070, Payment of tax; returns; estimated tax; payment under ORS 321.045, Audit of returns; interest and penalties upon failure to file return or pay tax under ORS 321.560, penalty for nonpayment of credit purchase; interest under ORS 323.195, extension of time for reports and payment of tax; interest under ORS 323.365, and Failure to pay tax or timely file report under ORS 323.381.
Affiant’s Signature: ___________________________________
Signed and affirmed to before me on _________________ by ______________________________.
(Date) (Affiant’s Name)
Notary Signature: ____________________________________
Notary Public for the State of ____________________________
My Commission Expires: _______________________________
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