Tax Compliance Form.doc
DOC document 1 MB Posted
- Attached to
- ESET Protect Elite Product
- Solicitation number
- PE-55267-NONST-2026-000000031
- Issued by
- Jefferson County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia for suppliers bidding on state and local contract opportunities. The form requires suppliers to provide comprehensive tax identification information, including their 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 they will perform, clarify whether tangible personal property or goods will be sold, and provide details about any affiliated entities with their respective tax identification numbers. Additionally, suppliers must designate a person responsible for handling their tax issues, including that individual's name, telephone number, and email address.
The form serves as a verification mechanism to ensure supplier eligibility for contract award. Upon contract consideration, the information submitted will be forwarded by the State Entity to the Georgia Department of Revenue for determination of whether the supplier qualifies as a "prohibited source" under O.C.G.A. 50-5-82 or has outstanding tax issues. Suppliers are strongly encouraged to verify their current tax status and resolve any outstanding tax liabilities or missing tax returns prior to submission, as incomplete, missing, or erroneous data may delay or prohibit contract award verification. The completed form must be submitted via email to the Department of Revenue at tsd-state-contractors@dor.ga.gov in accordance with 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 .