tax_certification_affidavit.pdf
PDF 94 KB Posted
- Attached to
- COMPREHENSIVE WELLNESS PROGRAM SERVICES
- Solicitation number
- 25-S-058
- Issued by
- District of Columbia
About this file
This is a Tax Certification Affidavit file related to the District of Columbia's Comprehensive Wellness Program Services contract opportunity through Events DC (the Washington Convention and Sports Authority). The affidavit serves as a certification document that prospective contractors must complete and submit as part of their bid response. The document requires contractors to attest to their tax compliance status and certify that they are in good standing with all applicable federal, state, and local tax authorities. This certification is a standard requirement for government contract bidding in the District of Columbia and must be executed under penalty of perjury to verify the contractor's eligibility to receive the award.
The tax certification affidavit is a mandatory submission document that establishes the contractor's tax certification status as a prerequisite for contract award consideration. Contractors bidding on the Comprehensive Wellness Program Services contract must complete and submit this affidavit in accordance with District of Columbia procurement regulations. The affidavit confirms that the bidding entity has no outstanding tax liabilities and maintains compliance with all applicable tax obligations, which is a standard requirement for government contracts to ensure contractors are financially responsible and in good standing with the jurisdiction.
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Text version
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Chief Financial Officer Office of Tax and Revenue
Authorized Agent Name of Organization/Entity Business Address (include zip code) Business Phone Number
I hereby authorize the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue to release my tax information to an authorized representative of the District of Columbia agency with which I am seeking to enter into a contractual relationship. I understand that the information released will be limited to whether or not I am in compliance with the District of Columbia tax laws and regulations solely for the purpose of determining my eligibility to enter into a contractual relationship with a District of Columbia agency. I further authorize that this consent be valid for one year from the date of this authorization.
I hereby certify that I am in compliance with the applicable tax filing and payment requirements of the District of Columbia. The Office of Tax and Revenue is hereby authorized to verify the above information with the appropriate government authorities.
TAX CERTIFICATION AFFIDAVIT
Date
Office of Tax and Revenue, PO Box 37559, Washington, DC 20013
THIS AFFIDAVIT IS TO BE COMPLETED ONLY BY THOSE WHO ARE REGISTERED TO CONDUCT BUSINESS IN
THE DISTRICT OF COLUMBIA.
Authorized Agent Principal Officer Name and Title Square and Lot Information Federal Identification Number Contract Number Unemployment Insurance Account No.
Signature of Authorizing Agent Title
The penalty for making false statement is a fine not to exceed $5,000.00, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code §47-4106.
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Chief Financial Officer Office of Tax and Revenue
I hereby authorize the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue to release my tax information to an authorized representative of the District of Columbia agency with which I am seeking to enter into a contractual relationship. I understand that the information released will be limited to whether or not I am in compliance with the District of Columbia tax laws and regulations solely for the purpose of determining my eligibility to enter into a contractual relationship with a District of Columbia agency. I further authorize that this consent be valid for one year from the date of this authorization.
I hereby certify that I am in compliance with the applicable tax filing and payment requirements of the District of Columbia. The Office of Tax and Revenue is hereby authorized to verify the above information with the appropriate government authorities.
TAX CERTIFICATION AFFIDAVIT
Office of Tax and Revenue, PO Box 37559, Washington, DC 20013 THIS AFFIDAVIT IS TO BE COMPLETED ONLY BY THOSE WHO ARE REGISTERED TO CONDUCT BUSINESS IN THE DISTRICT OF COLUMBIA.
The penalty for making false statement is a fine not to exceed $5,000.00, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code §47-4106.
8.2.1.4029.1.523496.503679
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File details come from the government source that posted it. Updated .