Tax Compliance Form (2).doc
DOC document 1 MB Posted
- Attached to
- RFQ # 27-23 Fortis G1m 11.6 Rugged Chromebook-HD-60 HZ & Google Chrome OS Education Mgmt Licenses
- Solicitation number
- PE-55267-NONST-2027-000000056
- Issued by
- Bartow County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia Department of Revenue for suppliers bidding on state and local contracts, specifically related to RFQ #27-23 for the Jones County School System's purchase of 100 HP Fortis G1m 11.6" Rugged HD-60 HZ Chromebooks and 100 Google Chrome OS Management Console Education Licenses. All suppliers must complete the form providing their legal name, physical location address, Federal Identification Number, and relevant state tax identification information including State Taxpayer Identification Number, Sales and Use Tax Number, and Withholding Tax Number. Suppliers must also identify the type of service to be performed, whether tangible personal property or goods will be sold, and provide information for any affiliated entities. Additionally, suppliers must designate a person responsible for handling the company's tax issues, including contact information such as name, telephone number, and email address.
The form serves as a tax compliance verification requirement for contract award consideration, with completed forms to be submitted by the state entity to the Georgia Department of Revenue for determination of eligibility. The state emphasizes that suppliers are prohibited from contract award if classified as a "prohibited source" as defined by O.C.G.A. 50-5-82 or if outstanding tax issues exist. Incomplete, missing, or erroneous data may delay or prevent verification of supplier eligibility; therefore, suppliers are strongly encouraged to verify their tax status and resolve any outstanding tax liabilities or missing tax returns prior to submission. The form was last revised on December 22, 2010, and serves as a standard procurement requirement under the Georgia Procurement Manual.
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Text version
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
File details come from the government source that posted it. Updated .