Final_Tax_Certification_Affidavit-NEW.pdf
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- Attached to
- LENEL ACCESS CONTROL MODERNIZATION AND INFASTRUCTURE UPGRADE SERVICES State and local contract opportunity
- Solicitation number
- 25-S-026
- Issued by
- District of Columbia
About this file
This is a Tax Certification Affidavit form issued by the Government of the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue, in connection with the Lenel Access Control Modernization and Infrastructure Upgrade Services contract opportunity solicited by the Washington Convention and Sports Authority t/a Events DC. The affidavit is required for all entities registered to conduct business in the District of Columbia seeking to enter into contractual relationships with DC agencies. By executing this form, authorized agents certify compliance with all applicable District of Columbia tax filing and payment requirements and authorize the Office of Tax and Revenue to verify tax compliance information with appropriate government authorities for the sole purpose of determining contractual eligibility.
The affidavit requires completion of standard identification fields including the authorized agent name, organization name, business address, phone number, principal officer information, federal identification number, unemployment insurance account number, contract number, and square and lot information. The authorization is valid for one year from the date of execution. The form includes a certification statement confirming the applicant's tax compliance status and notifies signatories that providing false statements constitutes a violation of D.C. Official Code 47-4106, carrying penalties of a fine not exceeding $5,000, imprisonment for not more than 180 days, or both. This document serves as a mandatory prerequisite for contract eligibility in the District of Columbia.
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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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File details come from the government source that posted it. Updated .