Final_Tax_Certification_Affidavit-NEW.pdf
PDF 94 KB Posted
- Attached to
- REMOVAL, SUPPLY, INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF CENTRIFUGAL CHILLER
- Solicitation number
- 25-S-033
- 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, required for the centrifugal chiller removal, supply, installation, inspection, maintenance, and repair procurement at the Walter E. Washington Convention Center. The affidavit serves as documentation that contractors seeking to enter into contractual relationships with District of Columbia agencies are in compliance with applicable District tax laws and regulations. The form authorizes the Office of Tax and Revenue to release tax compliance information to authorized representatives of the District agency administering the contract, with authorization valid for one year from the date of execution. The affidavit must be completed only by those registered to conduct business in the District of Columbia and requires certification of compliance with District tax filing and payment requirements, collection of authorized agent and principal officer information, and signature by an authorized representative, with false statements subject to penalties of up to $5,000 in fines, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code 47-4106.
This document is a mandatory compliance requirement for all contractors bidding on the chiller procurement. Submission of the completed tax certification affidavit is prerequisite to contract award, ensuring that selected contractors maintain current tax compliance status with the District of Columbia. The form is part of the broader compliance documentation package required from all bidders, which includes W-9 forms, Representations and Certifications, Equal Employment Opportunity Policy Statements, and disclosure statements regarding relationships with Events DC Board members and executive 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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