Blank TIN Form~19.docx
DOCX document 30 KB Posted
- Attached to
- Snow Removal J0301 Rockford
- Solicitation number
- 26-416CMS-BOPM4-B-52114
- Issued by
- Rock Island County, Illinois
About this file
This is a Taxpayer Identification Number (TIN) form required by the State of Illinois for bidders on the Snow Removal J0301 contract in Rockford. The form serves as certification that the submitting entity's taxpayer identification number is correct and that the entity is not subject to backup withholding by the Internal Revenue Service. The form accommodates various business structures including individuals, sole proprietorships, partnerships, corporations, limited liability companies, and tax-exempt organizations, each with specific instruction requirements regarding name entry, identification numbers, and supporting documentation such as IRS acceptance letters for corporations.
The form requires the authorized representative of the bidding entity to provide their name, business name, taxpayer identification number or Social Security number, legal status designation, and signature with date. Entities must certify their U.S. person status and compliance with federal backup withholding requirements. For corporations applying for snow removal services at 200 South Wyman in Rockford, Illinois, with a contract term from November 1, 2026 through April 30, 2031, submission of this completed TIN form is a mandatory prerequisite to bid consideration on this solicitation that is open to all qualified respondents.
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Other files
| File | Type | Posted |
|---|---|---|
| Snow Removal Contract J0301 Rockford__~1.docx | DOCX document | |
| Standard-Illinois-Certifications-v-26-2~15.pdf | ||
| Snow Removal J0301 Rockford Images.pdf |
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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 .