Tax Compliance Form
2 MB Posted
- Attached to
- JROTC Raider Challenge Obstacle Course
- Solicitation number
- 23-28
- Issued by
- Henry County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia for use in connection with Henry County's RFP 23-28 for digitization services and a separate JROTC Raider Challenge Obstacle Course construction project at Jones County High School. The form requires suppliers to provide comprehensive tax identification information, including Federal Identification Number (FEI), State Taxpayer Identification Number (STI), Sales and Use Tax Number, and Withholding Tax Number, along with details about any affiliates and the designated tax contact person. Suppliers must also disclose whether they have been previously registered in Georgia and specify the type of services to be performed and whether tangible personal property will be sold. For the digitization project specifically, Henry County is accepting proposals from qualified consultants to digitize files for the Building and Plan Review Department, with proposals due by 3:00 p.m. EST on December 7, 2022, submitted to Henry County Purchasing Department, 140 Henry Parkway, Room 209, McDonough, Georgia 30253. The JROTC obstacle course project requires an all-inclusive builder to construct a multi-use obstacle course at Jones County High School with consulting services provided throughout the planning and construction phases, ensuring compliance with all Georgia building codes and laws.
The critical compliance requirement is that all submitted tax information will be forwarded by the State Entity to the Georgia Department of Revenue for verification that the supplier is not a "prohibited source" under O.C.G.A. 50-5-82 and to confirm no outstanding tax issues exist. Missing, incomplete, or erroneous data may delay or prohibit contract award eligibility. Suppliers are strongly encouraged to verify their current tax status and resolve any outstanding tax liabilities or missing tax returns prior to submission. Proposals may not be withdrawn for sixty days after the closing date except as allowed by Georgia Code, and Henry County reserves the right to reject any and all proposals and waive any technicalities. Late bids will not be considered or returned.
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
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