Tax Compliance Form.pdf
PDF 65 KB Posted
- Attached to
- School Campus FY2025 Paving Project
- Solicitation number
- PE-55185-NONST-2025-000000003
- Issued by
- Schley County, Georgia
About this file
This is a Tax Compliance form (Attachment G) from the Georgia Department of Community Health (DCH) that must be completed by suppliers being considered for contract awards. The form collects essential tax-related information from suppliers including their business name, physical location, Federal Identification Number (FEI), Georgia state tax registration details (if applicable), type of services to be performed, and whether tangible goods will be sold. The form also requires information about any supplier affiliates and designates a person responsible for handling tax matters.
The form serves as a verification tool where DCH submits the completed information to the Georgia Department of Revenue (DOR) to determine if the supplier is a "prohibited source" as defined by O.C.G.A. §50-5-82 or has any outstanding tax issues. Suppliers are strongly encouraged to check their tax status and resolve any outstanding liabilities or missing returns, as prohibited sources cannot receive contract awards. The form is submitted by DCH to DOR via email at tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| FY 2025 Paving Bid.pdf | ||
| SPD_SP012CertificateofNonCollusion (2).pdf | ||
| Immigration and Security Form.pdf | ||
| Paving Survey.pdf | ||
| SPD_SP042SupplierGeneralInformationWorksheet .pdf |
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Text version
ATTACHMENT G - 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:
o State Taxpayer Identification Number (STI):
o Sales and Use Tax Number:
o Withholding Tax Number:
What type of service will you perform?
Will you sell any tangible personal property or goods?
Supplier’s Affiliate’s Name:
o FEI:
o STI:
o Sales and Use Tax Number:
o 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.):
o Name:
o Telephone Number:
o 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.
DCH will submit this form via email to DOR at tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.
File details come from the government source that posted it. Updated .