Exhibit B-W-9 Form.pdf
PDF 157 KB Posted
- Solicitation number
- 25RFP18004
- Issued by
- Minnehaha County, South Dakota
About this file
This is a Substitute W-9 Form (BFM-0001, Version 03/201907) issued by the State of South Dakota for vendor tax identification and payment processing purposes in conjunction with the South Dakota Department of Education's Division of Child and Adult Nutrition Services processing contract opportunity for bulk liquid eggs. The form requires vendors to provide their legal name, entity designation, taxpayer identification number (TIN), business addresses for order and remittance purposes, and banking information for direct deposit. Vendors must certify under penalty of perjury that the TIN provided is correct, that they are not subject to backup withholding by the Internal Revenue Service, and that they are a U.S. person or U.S. resident alien. The form includes optional direct deposit information with fields for bank account numbers, routing numbers, and account holder names, along with a required email address for electronic notification of state payments and access to the South Dakota Vendor Self Service website. A mandatory Letter of Intent is due by December 1, 2025, sample taste testing of 15 servings for each of the six end products must be submitted to five specified schools by December 8, 2025, and formal proposals are due December 22, 2025, by 5:00 PM CT, with contract award anticipated for January 13, 2026, and contract start date of July 1, 2026, for an initial 12-month term through June 30, 2027, with options for renewal.
The State of South Dakota retains the right to extend the contract for an additional four years and renew for additional one-year terms if mutually agreed upon. Vendors must meet specific insurance requirements including commercial general liability of at least $1,000,000 per occurrence, business automobile liability insurance of $1,000,000 per accident, and professional liability insurance of $1,000,000. All qualified vendors must be approved USDA National Processing Agreement Commodity Processors with pre-approved end products manufactured under USDA inspection, HACCP programs, and Total Quality Control standards. Bid pricing must include all transportation costs for delivery to Nordica Warehouses, Inc. in Sioux Falls, South Dakota, within 30 days of purchase order receipt, with maximum monthly delivery not exceeding 4,000 pounds. Evaluation criteria allocate 25 points for cost and reliability, 15 points for marketability (sample taste testing), 10 points for nutritional contribution, and 10 points for labeling requirements. Contractors must certify compliance with Executive Order 2023-02 prohibiting organizations ultimately owned or controlled by foreign nationals from China, Iran, North Korea, Russia, Cuba, or Venezuela. The State reserves the right to reject any or all proposals and potentially divide services among multiple contractors.
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Text version
State of South Dakota
BFM-0001 (V03/201907)
Substitute W-9
SEND TO THE STATE AGENCY
YOU SEND INVOICES
DO NOT send to IRS
Taxpayer Identification Number (TIN) Verification Print or Type Please see attachment or reverse for complete instructions.
This form can be made available in alternative formats to qualified individuals upon request.
Legal Name (as entered with IRS) If Sole Proprietorship enter your Last, First MI
Entity Designation (check only one) Required
Individual / Sole Proprietor Partnership C Corporation S Corporation Limited Liability Company - Individual Limited Liability Company - Partnership Limited Liability Company - Corporation Governmental Entity Hospital Exempt from Tax or Government Owned
Long Term Care Facility Exempt from Tax or Government Owned
Trust/Estate All Other Entities (specify e.g. 501(c)(3), etc.)
Taxpayer Identification Number (TIN)
Business Name If doing business as (DBA) or enter business name of Sole Proprietorship
Order Address (where order should be mailed) PO Box or Number and Street, City, State, ZIP + 4
Remit Address (where check should be mailed) PO Box or number and street, City, State, ZIP + 4
Exemptions Check Only One Required
Social Security Number (SSN) Employer Identification Number (EIN) Individual Taxpayer Identification Number for U.S. Resident Aliens (ITIN)
Exempt payee code (if any):
Exemption from FATCA reporting code (if any):
Certification Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number, AND
2. I am not subject to back up 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 back up 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.
3. I am a U.S. person (including a US resident alien).
Printed Name Printed Title Telephone Number
Signature Date (mm/dd/yy)
Optional Direct Deposit Information Your Bank Account Number Checking
Savings Bank Routing Number (9-digit ABA #) Name on Bank Account
THIS IS A:
new direct deposit change of existing (providing old banking information required to change existing)
Old Bank Account Number Old Routing Number (9-digit ABA #) You must provide the previous banking information to make a change.
Required e-mail address (Please make this LEGIBLE)
If you provide an email address you will be sent electronic notification when a payment is issued. You will also receive a PIN for use when logging into the SD Vendor Self Service website at http://bfm.sd.gov/vendor. We will NOT share your email address with anyone or use it for any purpose other than communicating remittance information.
Information below to be completed by the State Agency. Vendor Number required for any new vendors added to SDAS.
State Agency: Agency Contact: Date: Vendor Number assigned by SDAS:
| Business Name If doing business as DBA or enter business name of Sole Proprietorship: |
| Individual Sole Proprietor: Off |
| Partnership: Off |
| C Corporation: Off |
| S Corporation: Off |
| Limited Liability Company Individual: Off |
| Limited Liability Company Partnership: Off |
| Limited Liability Company Corporation: Off |
| Governmental Entity: Off |
| Hospital Exempt from Tax or Government: Off |
| Long Term Care Facility Exempt from Tax or: Off |
| TrustEstate: Off |
| All Other Entities specify eg 501c3 etc: Off |
| Social Security Number SSN: Off |
| Employer Identification Number EIN: Off |
| Individual Taxpayer Identification Number: Off |
| Printed Name: |
| Printed Title: |
| Telephone Number: |
| Date mmddyy: |
| Checking: Off |
| Savings: Off |
| Name on Bank Account: |
| new direct deposit: Off |
| change of existing providing old banking information required to change existing: Off |
| Old Bank Account Number: |
| Exempt Payee code (if any): |
| FATCA reporting code (if any): |
| Bank Account Number: |
| Bank Routing Number: |
| Old Routing Number: |
| e-mail address: |
| Legal Name as entered with IRS: |
| Order Address where order should be mailed: |
| Remit Address where check should be mailed: |
| Text5: |
| Text6: |
| Text1: |
| Text2: |
| Text3: |
| Text4: |
| Text9: |
| Text8: |
| Text10: |
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