illinois-business-affidavit-01-02.pdf
PDF 176 KB Posted
- Solicitation number
- 26-418DCFS-PROCU-B-49105
- Issued by
- Illinois
About this file
The document is an Illinois Business Affidavit form issued by the Independent Procurement Office, specifically related to the Illinois Procurement Code (30 ILCS 500/45-105). The form requires bidders to submit documentation proving they are an Illinois-based business to be eligible for a 4% bid preference. Vendors must complete the form, attest to their Illinois business status, and attach supporting documentation demonstrating their qualification under the state procurement regulations.
The affidavit includes a critical warning that contractors who provide false information to obtain the Illinois business preference may be subject to disciplinary procedures, including potential suspension or debarment for up to 10 years. The form requires the vendor to sign and provide their printed name, title, and date, certifying their status as an Illinois business. While the specific procurement opportunity is not detailed in this document, it serves as a mandatory compliance form for vendors seeking to bid on state contracts with a preference for local businesses.
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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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