Sole.Source.and.W.9.pdf

Office of the Secretary of State Budget & Fiscal Management Department

SMALL PURCHASE WITH SOLE SOURCE OR IMMEDIATE NEED CONDITIONS

Obligation Number: _2_6C_M_ 0_13_0_0_8 _____ _

Part 1 - General Information

Short Description: Rental of venue foruregent press conference held on 11 /18/25 in Chicago.

Vendor: \Moonlight Studios Inc

Estimated Value : \~$_4_0_0_0 ____ ~

Part 2 - Purchase History

Has the agency purchased these supplies or services in the past five years?

If YES, please describe:

Part 3 - Business Rationale

What are the specifications of the goods and/or services that you need?

□ Yes fl No

Studio for press conference, table and seating rental, green room availability from 7 am - 12 pm.

Why can the goods/services needed only be provided by this vendor, or why are they an immediate need?

This was an urgent rental for press conference for digital ID. This vendor had availablity when needed and had coordinated ability for AV and staging needed for event.

What will be the financial or other impact to the agency if this Small Purchase with Sole Source/Immediate Need Conditions purchase is not approved?

Press needed for organized mass awareness campaign regarding digital ID available on Apple wallet for Illinois constituents.

Is there any additional information you would like to add to justify this Small Purchase with Sole Source/Immediate Need Conditions?

Printed by authority of the State of lllinois . July 2025 - I - BFM 67.1

Form W•9 (Rev. March 2024)

Request for Taxpayer Identification Number and Certification e partm

I Rent of the

Tre~sury Go to www.irs.gov/FormW9 for instructions and the latest information.

n erna evenue ervIce

Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.

Give form to the requester. Do not send to the IRS.

1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded entity's name on line 2.)

Moonliaht Studios, Inc 2 Business name/disregarded entity name, if different from above.

C? 3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check 4 Exemptions (codes apply only to

CJ)

Cl only one of the following seven boxes. certain entities, not individuals;

"' a.

□ D C corporation 0 S corporation D Partnership D Trust/estate see instructions on page 3):

C Individual/sole proprietor

. "' □ LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) Exempt payee code (if any) G> C: ---i~ Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax

~ 2 classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate Exemption from Foreign Account Tax box for the tax classification of its owner. Compliance Act (FATCA) reporting

'E 't; □ Other (see instructions) code (ii any) ·.:: .s

a. u ~ 3b If on line 3a you checked "Partnership" or "Trust/estate," or checked "LLC" and entered "P" as its tax classification, (Applies to accounts maintained Q) and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check outside the United States.)

~ this box if you have any foreign partners, owners, or beneficiaries. See instructions

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5 Address (number, street, and apt. or suite no.). See instructions. Requester's name and address (optional) CJ) Cl)

1446 W. Kinzie Street 6 City, state, and ZIP code

Chicaao IL 60642 7 List account number(s) here (optional)

■ ::r.1 -- Taxpayer Identification Number (TIN) I Social security number I Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later.

DJJ-OJ-1 I I I I

or I Employer identification number

Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter. 4 6 - 2 9 6 1 3 7 3

Certification Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup 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 backup 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; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not requi red to sign the certification, but you must provide your correct TIN. See the instructions for Part 11 , later.

Sign Signature of Here U.S. person

General Instructions Section references are to the Internal Revenue Code unless otherwise noted.

Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.

What's New Line 3a has been modified to clarify how a disregarded entity completes this line. An LLC that is a disregarded entity should check the appropriate box for the tax classification of its owner. Otherwise, it should check the "LLC" box and enter its appropriate tax classification.

Cat. No. 10231X

Date 01-01-2025

New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or indirect foreign partners, owners, or beneficiaries when it provides the Form W-9 to another flow-through entity in which it has an ownership interest. This change is intended to provide a flow-through entity with information regarding the status of its indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1065).

Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS is giving you this form because they

Form W-9 (Rev. 3-2024)