Tax Compliance Form
2 MB Posted
- Attached to
- Definium Tempo Pro & OTS System
- Solicitation number
- 82000-ATC0000055
- Issued by
- Douglas County, Georgia
About this file
This Tax Compliance Form is required by the State of Georgia for suppliers bidding on state and local contracts, including the Definium Tempo Pro and OTS System procurement issued by the Technical College System of Georgia on behalf of Albany Technical College. Suppliers must complete comprehensive tax information including their federal identification number, state taxpayer identification number, sales and use tax number, and withholding tax number. The form requires suppliers to identify the type of services they will perform, whether they will sell tangible personal property, and to provide contact information for the person responsible for handling the supplier's tax issues. No specific response dates, due dates, site visits, or bidder meetings are outlined in this compliance form itself, as it functions as a prerequisite documentation requirement rather than a solicitation document with timeline specifications.
The Georgia Department of Revenue will use the submitted tax compliance information to verify that suppliers are not "prohibited sources" as defined by O.C.G.A. 50-5-82 and to identify any outstanding tax liabilities or missing tax returns. Suppliers are strongly encouraged to resolve any tax issues prior to contract consideration, as missing, incomplete, or erroneous data may delay or prohibit contract award eligibility. The state entity must submit the completed form to the Georgia Department of Revenue at tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual. No prohibited source may receive contract award, making tax compliance verification a mandatory prerequisite to award for any supplier bidding on this one-time purchase of medical imaging equipment for Albany Technical College's Radiologic Technology Program.
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
Other files
| File | Type | Posted |
|---|---|---|
| NOIA & Bid Tabulation | — | |
| Notice of Award | — | |
| Contractor Everify Affidavit | — |
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