tax_certification_affidavit.pdf
PDF 94 KB Posted
- Attached to
- RFQ - APPLIANCE MAINTENANCE AND REPAIR SERVICES
- Solicitation number
- 25-S-023
- 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, in support of the RFQ for Appliance Maintenance and Repair Services solicited by the Washington Convention and Sports Authority t/a Events DC. The affidavit serves as a mandatory compliance document for entities registered to conduct business in the District of Columbia that are seeking to enter into contractual relationships with DC agencies. The form requires authorized agents and principal officers to certify their compliance with applicable DC tax filing and payment requirements, authorize the Office of Tax and Revenue to release tax information to verify eligibility, and provide business registration details including Federal Identification Number, Unemployment Insurance Account Number, Square and Lot Information, and Contract Number. The authorization granted through this affidavit is valid for one year from the date of execution.
This RFQ is designated exclusively for District of Columbia Department of Small and Local Business Development (DSLBD) certified local, small, or disadvantaged business enterprises. Submission of the Tax Certification Affidavit is a requirement for all bidders seeking to demonstrate their eligibility and tax compliance status prior to contract award. False statements made in the affidavit are subject to penalties including fines not to exceed $5,000, imprisonment for not more than 180 days, or both, pursuant to D.C. Official Code 47-4106. Interested bidders must access the complete RFQ and submission instructions through Events DC's e-procurement website at https://eventsdc.com/about/procurement.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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
| TextField4: |
| TextField1: |
| SignatureField1: |
File details come from the government source that posted it. Updated .