illinois-business-affidavit-01-02.pdf
PDF 176 KB Posted
- Solicitation number
- 25-418DCFS-PROCU-B-46596
- Issued by
- Illinois
About this file
The Illinois Business Affidavit is a procurement document issued by the Independent Chief Procurement Office (ICPO) for state contract opportunities, specifically aligned with the Illinois Procurement Code (30 ILCS 500/45-105). This form requires bidders to demonstrate and attest that they qualify as an Illinois business, which makes them eligible for a 4% bid preference. The affidavit must be submitted with supporting documentation at the time of bid submission, verifying the vendor's status as an Illinois-based business.
The document outlines serious consequences for providing false information, including potential suspension or debarment for up to 10 years if a contractor is found to have misrepresented their business status. The affidavit requires vendors to complete contact information, confirm their Illinois business status, attach supporting documentation, and have an authorized officer or employee sign the document, thereby attesting to the accuracy of the information provided. This form is a critical component of ensuring transparency and compliance in Illinois state procurement processes, with specific legal protections and requirements designed to support local businesses.
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Text version
Illinois Business Affidavit (30 ILCS 500/45-105)
Background
Pursuant to 30 ILCS 500/45-105, bidder must submit this Affidavit and other supporting documents demonstrating that the bidder is an Illinois business as defined in Section 45-105 of the Illinois Procurement Code at the time of submission of the bid.
Contact Information
Vendor Name: Doing Business As:
University: Bulletin/Solicitation Number:
Illinois Business
Vendor is an Illinois business as defined in 30 ILCS 500/45-105 (required) Yes
Supporting Documents
Supporting documents must demonstrate the bidder is an Illinois business and is eligible for a 4% bid preference under 30 ILCS 500/45-105.
Supporting documentation is attached (required) Yes
Attestation
A contractor who is awarded a contract through the use of a preference for Illinois businesses and provides false information in order to obtain the preference is subject to disciplinary procedures as identified in 30 ILCS 500/50-65, including suspension/debarment for a period of up to 10 years.
Vendor attests it is an Illinois business pursuant to 30 ILCS 500/45-105. This affidavit is signed by an authorized officer or employee on behalf of the bidder pursuant to 30 ILCS 500/45-105.
Signature Field Printed Name Title Date
Illinois Business Affidavit Page 1 of 1 Version 25.1
Illinois Business Affidavit (30 ILCS 500/45-105) Background Pursuant to 30 ILCS 500/45-105, bidder must submit this Affidavit and other supporting documents demonstrating that the bidder is an Illinois business as defined in Section 45-105 of the Illinois Procurement Code at the time of submission of the bid.
Contact Information Illinois Business Vendor is an Illinois business as defined in 30 ILCS 500/45-105 (required) Supporting Documents Supporting documents must demonstrate the bidder is an Illinois business and is eligible for a 4% bid preference under 30 ILCS 500/45-105.
Supporting documentation is attached (required) Attestation A contractor who is awarded a contract through the use of a preference for Illinois businesses and provides false information in order to obtain the preference is subject to disciplinary procedures as identified in 30 ILCS 500/50-65, including suspension/debarment for a period of up to 10 years. Vendor attests it is an Illinois business pursuant to 30 ILCS 500/45-105. This affidavit is signed by an authorized officer or employee on behalf of the bidder pursuant to 30 ILCS 500/45-105.
Illinois Business Affidavit Page 1 of 1 Version 25.1 6.5.0.20211215.13
| VendorName: |
| DBA: |
| University: |
| BulletinNumber: |
| IBYes: 0 |
| Checkbox2: 0 |
| VendorSignature: |
| VendorPrintedName: |
| VendorTitle: |
| VendorDate: |
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