tax_certification_affidavit_.pdf
PDF 94 KB Posted
- Solicitation number
- 25-S-063
- Issued by
- District of Columbia
About this file
This is a Tax Certification Affidavit form issued by the Government of the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue, required in connection with a Request for Quotation from Events DC for Arbitrage Rebate Computation and Municipal Continuing Disclosure Report Services. The affidavit must be completed by organizations registered to conduct business in the District of Columbia that are seeking to enter into a contractual relationship with a District of Columbia agency. The form authorizes the Office of Tax and Revenue to release tax compliance information to the contracting agency for a one-year period from the date of authorization. The affidavit requires the contractor to certify compliance with all applicable District of Columbia tax filing and payment requirements and permits the Office of Tax and Revenue to verify this information with appropriate government authorities.
The form requires submission of specific organizational information including the authorized agent name, business address, phone number, federal identification number, contract number, unemployment insurance account number, square and lot information, and signatures from both the authorized agent and principal officer. False statements on the affidavit are subject to penalties of up to $5,000 in fines, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code 47-4106. This document serves as a prerequisite eligibility requirement for contractors bidding on District of Columbia contracts.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment_A.pdf | ||
| STANDARD_CONTRACT_PROVISIONS_(2)_(1).pdf | ||
| OCPS_Disclosure_Statement.pdf | ||
| Form_W-9_.pdf | ||
| 2020_ACH_FORM_(2).pdf | ||
| RFQ_25-S-_063_Arbitrage_Services.pdf |
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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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