Final_Tax_Certification_Affidavit-NEW_(1).pdf
PDF 94 KB Posted
- Attached to
- COOLING TOWER REPLACEMENT SERVICES
- Solicitation number
- 25-S-030
- Issued by
- District of Columbia
About this file
This is a Tax Certification Affidavit issued by the Government of the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue, for use in connection with the Cooling Tower Replacement Services contract opportunity at the Walter E. Washington Convention Center. The affidavit authorizes the District of Columbia to release tax compliance information to Events DC (the Washington Convention and Sports Authority) to verify the bidder's eligibility to enter into a contractual relationship. The document must be completed by all organizations registered to conduct business in the District of Columbia and requires certification of compliance with applicable District tax filing and payment requirements. The affidavit captures essential organizational information including the authorized agent name, business address and phone number, federal identification number, unemployment insurance account number, contract number, and square and lot information. The authorization remains valid for one year from the date of execution.
The affidavit imposes strict penalties for false statements, including fines up to $5,000, imprisonment for up to 180 days, or both, as prescribed by D.C. Official Code 47-4106. All bidders responding to the Cooling Tower Replacement Services solicitation must submit a completed and signed Tax Certification Affidavit as a required compliance document, along with a W-9 form, ACH authorization form, and Disclosure Statement. This tax certification requirement applies to all vendors seeking to contract with Events DC and is part of the District of Columbia's standard procurement process to ensure contractor eligibility and compliance with local tax obligations.
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Text version
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Chief Financial Officer Office of Tax and Revenue
Authorized Agent Name of Organization/Entity Business Address (include zip code) Business Phone Number
I hereby authorize the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue to release my tax information to an authorized representative of the District of Columbia agency with which I am seeking to enter into a contractual relationship. I understand that the information released will be limited to whether or not I am in compliance with the District of Columbia tax laws and regulations solely for the purpose of determining my eligibility to enter into a contractual relationship with a District of Columbia agency. I further authorize that this consent be valid for one year from the date of this authorization.
I hereby certify that I am in compliance with the applicable tax filing and payment requirements of the District of Columbia. The Office of Tax and Revenue is hereby authorized to verify the above information with the appropriate government authorities.
TAX CERTIFICATION AFFIDAVIT
Date
Office of Tax and Revenue, PO Box 37559, Washington, DC 20013
THIS AFFIDAVIT IS TO BE COMPLETED ONLY BY THOSE WHO ARE REGISTERED TO CONDUCT BUSINESS IN
THE DISTRICT OF COLUMBIA.
Authorized Agent Principal Officer Name and Title Square and Lot Information Federal Identification Number Contract Number Unemployment Insurance Account No.
Signature of Authorizing Agent Title
The penalty for making false statement is a fine not to exceed $5,000.00, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code §47-4106.
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Chief Financial Officer Office of Tax and Revenue
I hereby authorize the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue to release my tax information to an authorized representative of the District of Columbia agency with which I am seeking to enter into a contractual relationship. I understand that the information released will be limited to whether or not I am in compliance with the District of Columbia tax laws and regulations solely for the purpose of determining my eligibility to enter into a contractual relationship with a District of Columbia agency. I further authorize that this consent be valid for one year from the date of this authorization.
I hereby certify that I am in compliance with the applicable tax filing and payment requirements of the District of Columbia. The Office of Tax and Revenue is hereby authorized to verify the above information with the appropriate government authorities.
TAX CERTIFICATION AFFIDAVIT
Office of Tax and Revenue, PO Box 37559, Washington, DC 20013 THIS AFFIDAVIT IS TO BE COMPLETED ONLY BY THOSE WHO ARE REGISTERED TO CONDUCT BUSINESS IN THE DISTRICT OF COLUMBIA.
The penalty for making false statement is a fine not to exceed $5,000.00, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code §47-4106.
8.2.1.4029.1.523496.503679
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