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 from the Government of the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue, applicable to the Lenel Access Control Modernization and Infrastructure Upgrade Services procurement at the Walter E. Washington Convention Center. The affidavit must be completed by all entities registered to conduct business in the District of Columbia seeking to enter into a contractual relationship with a D.C. agency. The form requires authorized agents and principal officers to certify compliance with applicable D.C. tax filing and payment requirements, authorize the Office of Tax and Revenue to release tax information to the contracting agency for eligibility verification, and provide essential business identification including the organization name, business address, phone number, 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, and the Office of Tax and Revenue is authorized to verify the provided information with appropriate government authorities.
False statements on this affidavit carry significant penalties under D.C. Official Code 47-4106, including fines up to $5,000, imprisonment for up to 180 days, or both. Prospective bidders for the Lenel Access Control Modernization project must complete and submit this certification as a compliance requirement, as the procurement includes a 35 percent set-aside for Certified Business Enterprises and requires documentation of tax compliance status prior to contract award for any firm seeking to do business with 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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