Blank TIN Form~29.docx

This is a Taxpayer Identification Number (TIN) form issued by the State of Illinois, used in conjunction with a pest control services procurement opportunity at site D4420 located at 2400 S. Dirksen Parkway in Springfield, Illinois. The form serves as a certification document requiring vendors to provide their correct taxpayer identification number and confirm their U.S. person status and backup withholding compliance with the Internal Revenue Service. Vendors must complete the form by entering their name and corresponding Social Security Number (for individuals and sole proprietors) or Employer Identification Number (for business entities), and selecting their legal status classification from the available options, which include individual, sole proprietor, partnership, corporation, limited liability company, and various other entity types. The form requires an authorized representative's signature and date of completion.

This documentation is required for vendors seeking to participate in the Illinois pest control services contract opportunity, which is restricted to Small Business Set Aside Program vendors only. The form establishes the vendor's tax identification credentials and legal entity status as a prerequisite for bid submission and potential contract award. Vendors providing or billing medical and health care services, including pharmacies and funeral homes, must indicate their specific tax classification. Upon completion and submission, this form enables the State of Illinois to maintain accurate vendor records and ensure compliance with federal tax reporting requirements.