E-TIN-R-337360.pdf
PDF 85 KB Posted
- Contract number
- 27-426DOC-HILLC-P-101951
- Issued by
- Illinois
About this file
This is a State of Illinois Taxpayer Identification Number (TIN) form, version 23.2, issued by the State of Illinois Chief Procurement Office General Services. The form certifies the taxpayer identification information for Ethan Miller, who operates E&N Service Company, a corporation not providing or billing medical and/or health care services. The entity's Employer Identification Number is 92-2046429.
The form serves as a certification document in which the authorized representative attests that the provided EIN is correct, that the entity is not subject to backup withholding by the Internal Revenue Service, and that the entity qualifies as a U.S. person. The form was signed and dated August 17, 2026. This document is a prerequisite administrative requirement for state and local contract award processes and does not contain pricing terms, goods or services specifications, option periods, or contract amounts.
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| File | Type | Posted |
|---|---|---|
| upload_337360_BOA.pdf |
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
State of Illinois Chief Procurement Office General Services 10 Taxpayer Identification Number V.23.2
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: Ethan Miller
Business Name: E&N Service Company Taxpayer Identification Number:
Social Security Number:
or
Employer Identification Number: 92-2046429
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)
X Corporation NOT providing or billing C = corporation medical and/or health care services P = partnership
Signature of Authorized Representative:
Date: August 17, 2026
File details come from the government source that posted it. Updated .