Tax Compliance Form.pdf
PDF 121 KB Posted
- Solicitation number
- PE-92200-RFP-2026-000000073
- Issued by
- Fulton County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia, Department of Revenue (DOR), for use by suppliers bidding on state and local contract opportunities. The form requires suppliers to provide comprehensive tax registration information, including their Federal Identification Number (FEI), State Taxpayer Identification Number (STI), Sales and Use Tax Number, and Withholding Tax Number. Suppliers must disclose their physical location address, the type of services to be performed, whether tangible personal property or goods will be sold, and information regarding any affiliated entities. Additionally, suppliers must identify a person responsible for handling tax issues, including their name, telephone number, and email address.
The form serves as a verification mechanism for contract eligibility, as the State Entity will submit the completed information to the Georgia Department of Revenue to determine whether the supplier qualifies as a "prohibited source" under O.C.G.A. 50-5-82 or has any outstanding tax issues. Suppliers are strongly encouraged to resolve any outstanding tax liabilities or missing tax returns prior to submission, as missing, incomplete, or erroneous data may delay or prohibit contract award verification. No prohibited source may receive contract award. The completed form must be submitted by the State Entity via email to the Georgia Department of Revenue at tsd-state-contractors@dor.ga.gov for processing in accordance with the Georgia Procurement Manual.
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Text version
Revised: 12/22/2010 SPD-SP045
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.
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.
mailto:tsd-state-contractors@dor.ga.gov
File details come from the government source that posted it. Updated .