Form 2 - Tax and Regulatory Status Clearance Form~16.pdf
PDF 1 MB Posted
- Attached to
- ADA MENTOR PROTEGE PILOT PROGRAM
- Solicitation number
- B2727161
- Issued by
- Pennsylvania
About this file
This is a Tax and Regulatory Status Clearance Form (Form 2) related to the ADA Mentor Protege Pilot Program in Pennsylvania. The form serves as a certification document for bidders participating in this state contract opportunity. The program is designed to support disadvantaged business enterprises through mentorship relationships, with an Engineer's Estimate ranging from $1,000,000.00 to $2,000,000.00. Bidders are required to submit this form as part of the bid package, which includes a $200.00 bid processing fee. The form functions as a pre-qualification document to ensure that prospective contractors meet all applicable tax compliance and regulatory status requirements before their bids are considered for award.
The clearance form requires bidders to certify their current tax compliance status and regulatory standing at both state and local levels. This documentation is essential for establishing bidder eligibility and financial responsibility prior to contract award. The form ensures that only qualified contractors meeting Pennsylvania's regulatory and tax requirements may participate in the ADA Mentor Protege Pilot Program, thereby protecting the integrity of the procurement process and ensuring compliance with applicable state regulations and oversight mechanisms.
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Text version
FORM 2
CITY OF PHILADELPHIA TAX AND REGULATORY STATUS AND
CLEARANCE STATEMENT
THIS IS A CONFIDENTIAL TAX DOCUMENT NOT FOR PUBLIC DISCLOSURE
This form must be completed and returned with Respondnet's proposal in order for Respondent to be eligible for award of a concession agreement with the City. Failure to return this form will disqualify Respondent's proposal from further consideration by the contracting department.
Please provide the information requested in the table, check the appropriate certification option and sign below:
Respondent Name Contact Name and Title Street Address City, State, Zip Code Phone Number Federal Employer Identification Number or Social Security Number:
Philadelphia Business Income and Receipts Tax Account Number (f/k/a Business Privilege Tax) (if none, state “none”)* Commercial Activity License Number (f/k/a Business Privilege License) (if none, state “none”)*
____ I certify that the Respondent named above has all required licenses and permits and is current, or has made satisfactory arrangements with the City to become current with respect to the payment of City taxes or other indebtedness owed to the City (including, but not limited to, taxes collected by the City on behalf of the School District of Philadelphia), and is not in violation, or has made satisfactory arrangements to cure any violation, or other regulatory provisions applicable to Applicant contained in The Philadelphia Code.
___ I certify that the Respondent named above does not currently do business, or otherwise have an economic presence in Philadelphia. If Applicant is awarded a contract with the City, it promptly will take all steps necessary to bring it into compliance with the City’s tax and other regulatory requirements.
Authorized Signature Date
Print Name and Title
* You can apply for a City of Philadelphia Business Income and Receipts Tax Account Number or a Commercial Activity License on line after you have registered your business on the City’s Business Services website located at http://business.phila.gov/Pages/Home.aspx. Click on “Register” or “Register Now” to register your business.
| Applicant Name: |
| Contact Name and Title: |
| Street Address: |
| City State Zip Code: |
| Phone Number: |
| Federal Employer Identification Number or Social Security Number: |
| Philadelphia Business Income and Receipts Tax Account Number fka Business Privilege Tax if none state none: |
| Commercial Activity License Number fka Business Privilege License if none state none: |
| current or has made satisfactory arrangements with the City to become current with respect to: |
| an economic presence in Philadelphia If Applicant is awarded a contract with the City it: |
| Date: |
| Print Name and Title: |
| You can apply for a City of Philadelphia Business Income and Receipts Tax Account Number or a: |
File details come from the government source that posted it. Updated .