Tax Compliance Form
2 MB Posted
- Attached to
- Construction of the Henry County Aquatic Center
- Solicitation number
- 23-55
- Issued by
- Henry County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia for suppliers bidding on state and local contracts, specifically in connection with Henry County's RFP #23-55 for Construction of the Henry County Aquatic Center and Outdoor Water Park. 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. Suppliers must also disclose whether they have been previously registered in Georgia, identify the type of services to be performed, indicate whether tangible personal property or goods will be sold, and provide contact information for the person responsible for handling the supplier's tax issues. The Henry County Aquatic Center project, located at 1177 Henry Parkway Connector in McDonough, involved construction of a Type II A building housing a 50-meter competition pool, therapy warm pool, outdoor zero-entry pool, lazy river, activity pool, and water features or slides with associated sitework. The proposal deadline was July 13, 2023 at 3:00 p.m. local time, and proposals were to be submitted to the Henry County Purchasing Department at 140 Henry Parkway, Room 209, McDonough, GA 30253.
The Tax Compliance Form notification emphasizes that all information provided will be submitted by the State Entity to the Georgia Department of Revenue for verification that the supplier is not a "prohibited source" as defined by O.C.G.A. 50-5-82 and to identify any outstanding tax issues. Missing, incomplete, or erroneous data may delay or prohibit verification of supplier eligibility for contract award, and no prohibited source may receive contract award. Suppliers are strongly encouraged to check their tax status and resolve any outstanding tax liabilities or missing tax returns prior to submission. The State Entity must 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. The solicitation ultimately closed with no award, as no proposals were received by the deadline.
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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