Tax Compliance Form.pdf
PDF 121 KB Posted
- Solicitation number
- PE-92200-RFP-2027-000000085
- Issued by
- Fulton County, Georgia
About this file
This is a Tax Compliance Form issued by the State of Georgia in connection with a Building C Meeting Room Carpet Replacement Phase IV solicitation managed by the Georgia World Congress Center Authority. The form requires suppliers to provide comprehensive tax identification information, including 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, clarify whether tangible personal property or goods will be sold, and provide information regarding any affiliates involved in the contract. Additionally, suppliers must designate a person responsible for handling the supplier's tax issues, including contact information for that individual.
The form serves as a critical verification mechanism, as the State Entity will submit all provided information 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. Missing, incomplete, or erroneous data may delay or prevent verification of supplier eligibility for contract award, and no prohibited source may receive contract award. Suppliers are strongly encouraged to verify their tax status prior to submission and resolve any outstanding tax liabilities or missing tax returns. 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.
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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 .