Tax Compliance Form
2 MB Posted
- Attached to
- AV Equipment and Installation
- Solicitation number
- 23-39
- Issued by
- Georgia
About this file
This is a Tax Compliance Form instruction document issued by the State of Georgia for suppliers bidding on state and local contracts, specifically related to a Henry County, Georgia procurement for AV equipment and installation services. The form requires suppliers to provide complete business registration information, including the supplier's name, physical address, Federal Identification Number, and any applicable Georgia state tax identification numbers (State Taxpayer Identification Number, Sales and Use Tax Number, and Withholding Tax Number). Suppliers must also identify the type of service to be performed and whether tangible personal property will be sold, along with information regarding any affiliates and the person responsible for handling the supplier's tax issues. A pre-bid meeting for the AV equipment and installation project (Bid #23-39) is scheduled for March 1, 2023, at 11:30 AM Eastern Time via Zoom, with sealed bids due by 3:00 PM local time on March 21, 2023, to the Henry County Purchasing Department located at 140 Henry Parkway, Room 209, McDonough, GA 30253.
The Tax Compliance Form submission is mandatory for contract consideration, as the State of Georgia Department of Revenue will use the provided information to verify that the supplier is not a "prohibited source" under O.C.G.A. 50-5-82 and to identify any outstanding tax liabilities or missing tax returns. Missing, incomplete, or erroneous data may delay or prohibit verification of supplier eligibility for contract award, and no prohibited source may receive a contract award. Suppliers are strongly encouraged to verify their tax status and resolve any outstanding tax liabilities before submission. Completed forms must be submitted via email to the Georgia Department of Revenue at tsd-state-contractors@dor.ga.gov in accordance with the Georgia Procurement Manual. Bids may not be withdrawn for sixty days after the March 21, 2023, deadline, and Henry County reserves the right to reject any and all proposals and waive any technicalities.
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
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