illinois-business-affidavit-01-02.pdf
PDF 176 KB Posted
- Solicitation number
- 26-418DCFS-PROCU-B-49517
- Issued by
- Cook County, Illinois
About this file
Illinois Business Affidavit Summary
This document is an Illinois Business Affidavit form mandated by 30 ILCS 500/45-105, administered by the Independent Colleges Procurement Office. The affidavit serves as a certification mechanism for bidders to demonstrate their eligibility for state and local contract opportunities. Bidders must submit this form along with supporting documentation at the time of bid submission to verify their status as an Illinois business as defined in Section 45-105 of the Illinois Procurement Code. The form requires vendors to provide contact information including their business name, doing business as name, university affiliation, and the bulletin or solicitation number associated with the opportunity.
The affidavit requires vendors to attest under penalty of disciplinary action that they qualify as an Illinois business and are therefore eligible for a four percent bid preference under applicable state law. Supporting documentation must be attached to substantiate the bidder's Illinois business status. Contractors who knowingly provide false information to obtain the preference are subject to suspension or debarment for up to ten years pursuant to 30 ILCS 500/50-65. The form must be signed by an authorized officer or employee of the bidding organization, with signature, printed name, title, and date required on the document.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Rebid PO25-390 Mobile Fingerprint Scanners and Software Invitation for Bid ~6.docx | DOCX document | |
| vendor disclosure formerly forms a.docx | DOCX document | |
| Offer to the State of Illinois~2.pdf | ||
| it-standard-terms-and-conditions-v-25-4.pdf | ||
| PO25-390 Invitation for Bid Vendor Instructions and Requirements~7.docx | DOCX document | |
| ipg active registered vendor disclosure formerly forms b.docx | DOCX document |
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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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