Final_Tax_Certification_Affidavit-NEW.pdf
PDF 94 KB Posted
- Attached to
- URBAN BEEKEEPING SERVICES
- Solicitation number
- 25-S-050
- 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 Urban Beekeeping Services contract opportunity solicited by the Washington Convention and Sports Authority t/a Events DC. The affidavit must be completed only by entities registered to conduct business in the District of Columbia and serves as a prerequisite for contract eligibility. The form requires authorized agents and principal officers to certify compliance with applicable District of Columbia tax filing and payment requirements, authorize the Office of Tax and Revenue to release tax information to verify eligibility, and provide business registration details including Federal Identification Number, Unemployment Insurance Account Number, and contract number.
The Tax Certification Affidavit authorization is valid for one year from the date of execution and allows the Office of Tax and Revenue to verify tax compliance status with appropriate government authorities solely for determining contractual eligibility. Completion of this affidavit is mandatory for all bidders on District of Columbia contracts. False statements made on the affidavit are subject to penalties including fines up to $5,000, imprisonment for up to 180 days, or both, as prescribed by D.C. Official Code 47-4106. The form includes fields for business address, phone number, signature of the authorizing agent, title, square and lot information, and the date of authorization.
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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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