Exhibit VI Tax Compliance Form
2 MB Posted
- Attached to
- On-Call Geotechnical Drilling Services
- Solicitation number
- RFQ-484-08152022
- Issued by
- Georgia
About this file
This is a Tax Compliance Form issued by the Georgia Department of Revenue for use by the Georgia Department of Transportation (GDOT) in connection with an on-call geotechnical drilling services solicitation. Suppliers responding to GDOT's request for qualified firms to provide geotechnical and environmental drilling services—including bridge foundation drilling and sampling, soil survey drilling and sampling, wall foundation drilling and sampling, and environmental drilling and sampling—must complete this form. The solicitation establishes open agency contracts with an initial term of up to five years, with options for price adjustments at specified intervals. A virtual optional pre-bid meeting is scheduled for Thursday, July 28, 2022 at 10:00 AM. A communication restriction is in effect from the advertisement date until contract award announcement; respondents may only communicate with GDOT staff through submitted questions as instructed in the request for qualifications and certifications (RFQC).
The Tax Compliance Form requires suppliers to provide complete information including the supplier's name, physical location address, Federal Identification Number, State Taxpayer Identification Number, Sales and Use Tax Number, Withholding Tax Number, type of services to be performed, and contact information for the person responsible for tax issues. Upon contract award consideration, GDOT will submit the provided information to the Georgia Department of Revenue for verification that the supplier is not a "prohibited source" under O.C.G.A. 50-5-82 and has no outstanding tax issues. Missing, incomplete, or erroneous data may delay or prohibit contract award eligibility. Suppliers are advised to verify their current tax status and resolve any outstanding tax liabilities or missing tax returns before submission. The completed form must be submitted by the state entity to the Georgia Department of Revenue at compliance-state-con@dor.ga.gov in accordance with the Georgia Procurement Manual.
Text of this file
TAX COMPLIANCE
INSTRUCTIONS TO SUPPLIERS
Please complete the following information:
· Supplier’s Name:
· Physical Location Address:
· Federal Identification Number (FEI):
· Have you ever been registered with Georgia Department of Revenue?
· If so, please provide the following information, if applicable:
· State Taxpayer Identification Number (STI):
· Sales and Use Tax Number:
· Withholding Tax Number:
· What type of service will you perform?
· Will you sell any tangible personal property or goods?
· Supplier’s Affiliate’s Name:
· FEI:
· STI:
· Sales and Use Tax Number:
· Withholding Tax Number:
If there is more than one affiliate, please attach a separate sheet listing the information above.
· Person responsible for handling supplier’s tax issues (such as the CFO, the company tax officer, etc.):
· Name:
· Telephone Number:
· E-mail Address:
NOTICE TO SUPPLIER:
In the event the supplier is considered for contract award, the information provided in the form will be submitted by the State Entity to the Georgia Department of Revenue (“DOR”) for a determination as to whether the supplier is a “prohibited source” (as defined by O.C.G.A. §50-5-82) or whether there are any other outstanding tax issues. MISSING, INCOMPLETE, OR ERRONEOUS DATA MAY DELAY OR PROHIBIT VERIFICATION OF YOUR ELIGIBILITY FOR CONTRACT AWARD. NO PROHIBITED SOURCE MAY RECEIVE CONTRACT AWARD; THEREFORE, YOU ARE STRONGLY ENCOURAGED TO CHECK YOUR TAX STATUS NOW AND RESOLVE ANY OUTSTANDING TAX LIABILITIES AND/OR MISSING TAX RETURNS.
STATE ENTITY: Please submit this form via email to DOR at compliance-state-con@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.
Revised: 09/07/2021
SPD-SP045
An Equal Opportunity Employer
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