Tax Compliance Form
2 MB Posted
- Solicitation number
- 23-34
- Issued by
- Henry County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia in conjunction with Henry County's Invitation to Bid #23-34 for the purchase and installation of equipment on five 2022 Chevrolet Tahoe vehicles for the Police Department's K-9 units. The form requires suppliers to provide comprehensive tax identification information, including Federal Employer Identification Number (FEI), State Taxpayer Identification Number (STI), Sales and Use Tax Number, and Withholding Tax Number. Suppliers must also disclose whether they will sell tangible personal property or goods and identify any affiliates along with their corresponding tax information. A designated person responsible for handling the supplier's tax issues must be identified with contact information. Bids were due February 23, 2023 at 3:00 p.m. local time at the Henry County Purchasing Department, 140 Henry Parkway, Room 209, McDonough, Georgia 30253. The contractor was required to furnish all labor, materials, equipment, and services necessary to complete the installation. West Chatham Warning Devices Inc was awarded the contract in the amount of $126,006.25.
Suppliers selected for contract award will have their tax compliance information submitted to the Georgia Department of Revenue for verification of eligibility and determination of "prohibited source" status under O.C.G.A. 50-5-82. Missing, incomplete, or erroneous data may delay or prohibit contract award verification. No supplier classified as a prohibited source may receive contract award. State entities are instructed to submit the completed form via email to the Georgia Department of Revenue at tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual. Suppliers are strongly encouraged to verify their current tax status and resolve any outstanding tax liabilities or missing tax returns prior to bid submission. Bids could not be withdrawn for sixty days following the bid closing deadline, except as permitted by the Official Code of Georgia Annotated.
Text of this file
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 in the State of Georgia?
· 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 tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.
Revised: 12/22/2010
SPD-SP045
An Equal Opportunity Employer
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