Tax Compliance Form.doc
DOC document 1 MB Posted
- Attached to
- RFQ # 27-21 ESET Protect Elite Product
- Solicitation number
- PE-55267-NONST-2027-000000054
- 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 contracts, specifically in relation to RFQ #27-21 for ESET Protect Elite Product renewal by Jones County School System. The form requires suppliers to provide comprehensive tax and identification information, including the supplier's name, physical location, 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 details for any affiliates. Additionally, suppliers must designate a person responsible for handling tax issues and provide that individual's contact information.
The Georgia Department of Revenue will use the submitted information to verify that suppliers are not "prohibited sources" as defined by O.C.G.A. 50-5-82 and to identify any outstanding tax liabilities or missing tax returns. The form emphasizes that missing, incomplete, or erroneous data may delay or prevent contract award eligibility, and suppliers are 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. The form was last revised on December 22, 2010.
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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 .