SPD_SP045TaxComplianceForm(1).doc
DOC document 1 MB Posted
- Attached to
- FVSU- Poultry Lab Modifications` State and local contract opportunity
- Solicitation number
- PE-53300-RFP-2026-000000047
- Issued by
- Paulding County, Georgia
About this file
This document is a Tax Compliance Form for suppliers seeking to do business with the Georgia state government, specifically designed to verify a potential contractor's tax status with the Georgia Department of Revenue (DOR). The form requires detailed tax and business information from suppliers, including federal identification numbers, state taxpayer identification numbers, sales and use tax numbers, and withholding tax numbers. The primary purpose is to determine whether a supplier is a "prohibited source" with outstanding tax liabilities that would disqualify them from receiving a state contract.
The form mandates that suppliers provide comprehensive contact and tax information, with a clear warning that incomplete or incorrect data may delay or prevent contract award. If a supplier is considered for a contract, the submitted information will be forwarded to the DOR for verification. The document strongly encourages suppliers to proactively check their tax status and resolve any outstanding tax issues before seeking a state contract. The form was last revised on September 7, 2021, and is part of the state's procurement compliance process to ensure tax accountability among potential state contractors.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| ITB and Project Manual P100.pdf | ||
| DRAWINGS_P100 POULTRY LAB 7_1_25.pdf |
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Text version
TAX COMPLIANCE
INSTRUCTIONS TO SUPPLIERS
Please complete the following information:
· Supplier’s Name:
· Physical Location Address:
· Federal Identification Number (FEI):
· Have you ever been registered with Georgia Department of Revenue?
· If so, please provide the following information, if applicable:
· State Taxpayer Identification Number (STI):
· Sales and Use Tax Number:
· Withholding Tax Number:
· What type of service will you perform?
· Will you sell any tangible personal property or goods?
· Supplier’s Affiliate’s Name:
· FEI:
· STI:
· Sales and Use Tax Number:
· Withholding Tax Number:
If there is more than one affiliate, please attach a separate sheet listing the information above.
· Person responsible for handling supplier’s tax issues (such as the CFO, the company tax officer, etc.):
· Name:
· Telephone Number:
· E-mail Address:
NOTICE TO SUPPLIER:
In the event the supplier is considered for contract award, the information provided in the form will be submitted by the State Entity to the Georgia Department of Revenue (“DOR”) for a determination as to whether the supplier is a “prohibited source” (as defined by O.C.G.A. §50-5-82) or whether there are any other outstanding tax issues. MISSING, INCOMPLETE, OR ERRONEOUS DATA MAY DELAY OR PROHIBIT VERIFICATION OF YOUR ELIGIBILITY FOR CONTRACT AWARD. NO PROHIBITED SOURCE MAY RECEIVE CONTRACT AWARD; THEREFORE, YOU ARE STRONGLY ENCOURAGED TO CHECK YOUR TAX STATUS NOW AND RESOLVE ANY OUTSTANDING TAX LIABILITIES AND/OR MISSING TAX RETURNS.
STATE ENTITY: Please submit this form via email to DOR at compliance-state-con@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.
Revised: 09/07/2021
SPD-SP045
An Equal Opportunity Employer
File details come from the government source that posted it. Updated .