Blank TIN Form~19.docx
DOCX document 30 KB Posted
- Attached to
- Snow Removal J0301 Rockford
- Solicitation number
- 26-416CMS-BOPM4-B-51770
- Issued by
- Washington County, Illinois
About this file
This is a Taxpayer Identification Number (TIN) form for the State of Illinois, applicable to a snow removal services contract solicitation for the City of Rockford. The form serves as a certification document requiring bidders to provide their correct taxpayer identification information and confirm their tax compliance status. Bidders must complete fields for their name, business name, and either a Social Security Number or Employer Identification Number, along with selecting their legal status category from options including individual, sole proprietor, partnership, corporation, limited liability company, and various specialized entity types. The form requires an authorized representative's signature and date of completion.
The snow removal contract solicitation is for services at J0301, 200 South Wyman in Rockford, Illinois, with a contract period running from November 1, 2026 through April 30, 2031. This solicitation is set-aside exclusively for Small Business Set-Aside (SBSA) vendors registered in the Illinois Procurement Gateway (IPG) at the time of bid submission. Completion of this TIN form is a required submission element for all vendors seeking to bid on this contract opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| Standard-Illinois-Certifications-v-26-2~15.pdf | ||
| Snow Removal J0301 Rockford Images.pdf | ||
| Snow Removal Contract SBSA J0301 Rockford Contract_R~1.docx | DOCX document |
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
I certify that:
The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and I am a U.S. person (including a U.S. resident alien).
· If you are an individual, enter your name and SSN as it appears on your Social Security Card.
· If you are a sole proprietor, enter the owner’s name on the name line followed by the name of the business and the owner’s SSN or EIN.
· If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s name on the name line and the D/B/A on the business name line and enter the owner’s SSN or EIN.
· If the LLC is a corporation or partnership, enter the entity’s business name and EIN and for corporations, attach IRS acceptance letter (CP261 or CP277).
· For all other entities, enter the name of the entity as used to apply for the entity’s EIN and the EIN.
Name:
Business Name:
Taxpayer Identification Number:
Social Security Number:
or Employer Identification Number:
Legal Status (check one):
| |_| Individual | |_| Governmental | ||||
| |_| Sole Proprietor | |_| Nonresident alien | ||||
| |_| Partnership | |_| Estate or trust | ||||
| |_| Legal Services Corporation | |_| Pharmacy (Non-Corp.) | ||||
| |_| Tax-exempt | |_| Pharmacy/Funeral Home/Cemetery (Corp.) | ||||
| |_| Corporation providing or billing | |_| Limited Liability Company | ||||
| medical and/or health care services | (select applicable tax classification) | ||||
| |_| Corporation NOT providing or billing | |_| C = corporation | ||||
| medical and/or health care services | |_| P = partnership |
Signature of Authorized Representative:
Date: Click here to enter a date.
File details come from the government source that posted it. Updated .