RFP_25RFP13437_Exhibit B - Substitute_W-9_SD.pdf
IRS Form PDF 157 KB Posted
- Attached to
- CACFP Financial Management System
- Solicitation number
- 25RFP13437
- Issued by
- Pennington County, South Dakota
About this file
This document is a Substitute W-9 form from the State of South Dakota, Bureau of Finance and Management (BFM), used for Taxpayer Identification Number (TIN) verification. The form is required to be sent to the state agency from which the vendor receives invoices and payment, not to the Internal Revenue Service. The document serves as a standardized vendor registration and payment authorization form for individuals and entities conducting business with South Dakota state agencies. Vendors must complete all required fields including legal name, business name if applicable, entity designation, taxpayer identification number, order address, and remittance address. The form requires certification under penalty of perjury that the provided taxpayer identification number is correct and that the vendor is not subject to backup withholding by the IRS, and that the vendor is a U.S. person or resident alien.
The form includes optional direct deposit information sections allowing vendors to authorize electronic fund transfers to specified bank accounts, with separate provisions for initiating new direct deposits or modifying existing banking information. Vendors must provide a legible email address to receive electronic notification of payment issuance and to access the South Dakota Vendor Self Service website. Upon completion by the vendor, the form is submitted to the relevant state agency, which then assigns a vendor number through the South Dakota Accounting System (SDAS) and records the state agency name, contact person, date received, and vendor identification number. This form is the foundational documentation required for vendor enrollment and payment processing with South Dakota state government.
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Who attaches IRS Form W-9
| State | Files |
|---|---|
| Massachusetts | 7,066 |
| Texas | 1,095 |
| Colorado | 1,093 |
| New York | 906 |
| Florida | 624 |
Other files
| File | Type | Posted |
|---|---|---|
| RFP_25RFP13437 Exhibit G Security and Vendor Questions v3.2 Production.docx | DOCX document | |
| RFP Document.pdf | ||
| RFP_25RFP13437_Exhibit C_Certification re Prohibited Entity.pdf | ||
| RFP_25RFP13437 Exhibit F.docx | DOCX document | |
| RFP_25RFP13437_Exhibit B - Substitute_W-9_SD.pdf | ||
| Response to Offeror Questions document.docx | DOCX document | |
| RFP_25RFP13437 Exhibit E.pdf | ||
| RFP_25RFP13437 Exhibit D_BIT Contract Terms.docx | DOCX document | |
| RFP_25RFP13437_Exhibit C_Certification re Prohibited Entity.pdf | ||
| RFP_25RFP13437 Exhibit F.docx | DOCX document | |
| RFP_25RFP13437 Exhibit G Security and Vendor Questions v3.2 Production.docx | DOCX document | |
| RFP_25RFP13437 Exhibit D_BIT Contract Terms.docx | DOCX document | |
| RFP Document.pdf | ||
| RFP_25RFP13437 Exhibit E.pdf |
Show all 14
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Text version
State of South Dakota
BFM-0001 (V03/201907)
Substitute W-9
SEND TO THE STATE AGENCY
YOU SEND INVOICES
DO NOT send to IRS
Taxpayer Identification Number (TIN) Verification Print or Type Please see attachment or reverse for complete instructions.
This form can be made available in alternative formats to qualified individuals upon request.
Legal Name (as entered with IRS) If Sole Proprietorship enter your Last, First MI
Entity Designation (check only one) Required
Individual / Sole Proprietor Partnership C Corporation S Corporation Limited Liability Company - Individual Limited Liability Company - Partnership Limited Liability Company - Corporation Governmental Entity Hospital Exempt from Tax or Government Owned
Long Term Care Facility Exempt from Tax or Government Owned
Trust/Estate All Other Entities (specify e.g. 501(c)(3), etc.)
Taxpayer Identification Number (TIN)
Business Name If doing business as (DBA) or enter business name of Sole Proprietorship
Order Address (where order should be mailed) PO Box or Number and Street, City, State, ZIP + 4
Remit Address (where check should be mailed) PO Box or number and street, City, State, ZIP + 4
Exemptions Check Only One Required
Social Security Number (SSN) Employer Identification Number (EIN) Individual Taxpayer Identification Number for U.S. Resident Aliens (ITIN)
Exempt payee code (if any):
Exemption from FATCA reporting code (if any):
Certification Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number, AND
2. I am not subject to back up withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to back up withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
3. I am a U.S. person (including a US resident alien).
Printed Name Printed Title Telephone Number
Signature Date (mm/dd/yy)
Optional Direct Deposit Information Your Bank Account Number Checking
Savings Bank Routing Number (9-digit ABA #) Name on Bank Account
THIS IS A:
new direct deposit change of existing (providing old banking information required to change existing)
Old Bank Account Number Old Routing Number (9-digit ABA #) You must provide the previous banking information to make a change.
Required e-mail address (Please make this LEGIBLE)
If you provide an email address you will be sent electronic notification when a payment is issued. You will also receive a PIN for use when logging into the SD Vendor Self Service website at http://bfm.sd.gov/vendor. We will NOT share your email address with anyone or use it for any purpose other than communicating remittance information.
Information below to be completed by the State Agency. Vendor Number required for any new vendors added to SDAS.
State Agency: Agency Contact: Date: Vendor Number assigned by SDAS:
| Business Name If doing business as DBA or enter business name of Sole Proprietorship: |
| Individual Sole Proprietor: Off |
| Partnership: Off |
| C Corporation: Off |
| S Corporation: Off |
| Limited Liability Company Individual: Off |
| Limited Liability Company Partnership: Off |
| Limited Liability Company Corporation: Off |
| Governmental Entity: Off |
| Hospital Exempt from Tax or Government: Off |
| Long Term Care Facility Exempt from Tax or: Off |
| TrustEstate: Off |
| All Other Entities specify eg 501c3 etc: Off |
| Social Security Number SSN: Off |
| Employer Identification Number EIN: Off |
| Individual Taxpayer Identification Number: Off |
| Printed Name: |
| Printed Title: |
| Telephone Number: |
| Date mmddyy: |
| Checking: Off |
| Savings: Off |
| Name on Bank Account: |
| new direct deposit: Off |
| change of existing providing old banking information required to change existing: Off |
| Old Bank Account Number: |
| Exempt Payee code (if any): |
| FATCA reporting code (if any): |
| Bank Account Number: |
| Bank Routing Number: |
| Old Routing Number: |
| e-mail address: |
| Legal Name as entered with IRS: |
| Order Address where order should be mailed: |
| Remit Address where check should be mailed: |
| Text5: |
| Text6: |
| Text1: |
| Text2: |
| Text3: |
| Text4: |
| Text9: |
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