Tax Compliance Form
1 MB Posted
- Solicitation number
- 23-66
- Issued by
- Henry County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia for use in state and local contract opportunities, specifically referenced in relation to Henry County's RFP #23-66 for generator services and maintenance. 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 regarding any prior registration in Georgia and affiliate entities. Suppliers must also designate a person responsible for handling tax issues and specify the type of services to be performed and whether tangible personal property will be sold. The form serves as a prerequisite documentation requirement for contract award consideration, with proposals for the generator services and maintenance contract due to Henry County Purchasing Department by 3:00 PM on July 25, 2023. The successful contractor will provide service and scheduled maintenance for generators across various County buildings on a renewable annual contract basis.
The Georgia Department of Revenue will review submitted tax compliance information to verify that suppliers are not classified as "prohibited sources" under O.C.G.A. 50-5-82 and that no outstanding tax liabilities or missing tax returns exist. Incomplete, missing, or erroneous data may delay or prevent verification of eligibility for contract award, and no prohibited source may receive a contract award. Suppliers are strongly encouraged to resolve any outstanding tax issues prior to submission. The contract was awarded to Power and Energy Services in the amount of $35,653.78 on a renewable annual basis. The form must be submitted by the state entity to the Georgia Department of Revenue at tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.
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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