Blank TIN Form~28.docx
DOCX document 30 KB Posted
- Attached to
- Pest Control J0110 Spfld
- Solicitation number
- 27-416CMS-BOPM4-B-53705
- Issued by
- Sangamon County, Illinois
About this file
This is a Blank Taxpayer Identification Number (TIN) Form related to pest control services procurement by the State of Illinois for site J0110 located at 4500 South 6th Street, Springfield, Illinois 62703. The form serves as a template document for vendors to provide their TIN information as part of the bidding process. The document itself does not specify detailed project parameters such as service scope specifics, quantities, response deadlines, site visit requirements, bidders' conferences, or contract term details, as it is a blank administrative form rather than a complete procurement document.
This procurement is designated exclusively for Small Business Set Aside Program vendors, restricting participation to qualified small businesses. The form is an administrative requirement for vendor compliance and financial identification purposes. No pricing terms, incumbent information, funding amounts, or other financial details are specified within the blank form itself, as these elements would be contained in the primary solicitation documents and related scope of work materials accompanying this form.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Contract B-53705 Pest Control J0110 Spfld.docx | DOCX document | |
| Pre-Bid Walk Through Notice-Mandatory B-53705.docx | DOCX document | |
| Standard-Illinois-Certifications-v-26-2~28.pdf | ||
| Pest Control - Line Item 7 Pricing Instructions B-53705.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 .