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, related to the Cooling Tower Replacement Services procurement by the Washington Convention and Sports Authority (Events DC). The affidavit authorizes the District of Columbia to release tax compliance information to Events DC for the purpose of determining contractor eligibility to enter into a contractual relationship. The document requires completion only by entities registered to conduct business in the District of Columbia and certifies that the signing party is in compliance with applicable District of Columbia tax filing and payment requirements. The affidavit includes fields for the authorized agent name, organization/entity name, business address, phone number, federal identification number, contract number, unemployment insurance account number, square and lot information, and signatures from both the authorized agent and principal officer. The authorization granted by this affidavit is valid for one year from the date of execution.
The affidavit is a prerequisite submission requirement for the Cooling Tower Replacement Services contract opportunity and must be signed under penalty of perjury, with false statements subject to fines up to $5,000, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code 47-4106. This document demonstrates that prospective contractors must achieve and maintain compliance with District of Columbia tax laws and regulations as a condition of contract award and execution. The affidavit is one of several required submission documents for the proposal, alongside a W-9 form, ACH authorization form, and a Disclosure Statement certifying any relationships with Events DC Board members and key staff.
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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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