Tax ID Form~7.pdf
PDF 92 KB Posted
- Attached to
- EMA - Radiation Calibration Training- SM
- Solicitation number
- 27-588IEMA-MGMTA-B-54733
- Issued by
- Illinois
About this file
This is a State of Illinois Taxpayer Identification Number (TIN) form issued by the Chief Procurement Office for General Services, applicable to vendors seeking to register with the state. The form requires vendors to provide their correct taxpayer identification information, certify their tax compliance status, and disclose their legal business structure, which may include individual proprietorships, partnerships, corporations, limited liability companies, or tax-exempt entities. Additionally, vendors must disclose any existing or pending contracts, bids, proposals, subcontracts, leases, or other ongoing procurement relationships with units of the State of Illinois government, and identify any registered lobbyists or agents representing their interests in state procurement matters.
The form serves as a mandatory disclosure document for vendor registration and compliance purposes within Illinois' procurement system. It contains certification language regarding backup withholding exemptions and U.S. person status as required by the Internal Revenue Service. The form does not specify pricing terms, set-asides, funding amounts, or contract performance details; rather, it functions as a foundational vendor qualification and disclosure instrument. The related contract opportunity involves radiation calibration training services delivered onsite, requiring gamma calibration instruction for five participants and portable radiation instrument and dosimetry calibration training for up to twenty-four participants, though specific contract terms, timelines, and award information are not detailed in this tax identification form.
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Other files
| File | Type | Posted |
|---|---|---|
| R-339499 Radiation Calibration Training Statement of Work~2.docx | DOCX document | |
| standard terms and conditions~37.pdf |
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
State of Illinois Chief Procurement Office for General Services 4 IPG Active Registered Vendor Disclosure V.26.1
I certify that:
The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and
I am a U.S. person (including a U.S. resident alien).
• If you are an individual, enter your name and SSN as it appears on your Social Security Card.
• If you are a sole proprietor, enter the owner’s name on the name line followed by the name of the business and the owner’s SSN or EIN.
• If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s name on the name line and the D/B/A on the business name line and enter the owner’s SSN or EIN.
• If the LLC is a corporation or partnership, enter the entity’s business name and EIN and for corporations, attach IRS acceptance letter (CP261 or CP277).
• For all other entities, enter the name of the entity as used to apply for the entity’s EIN and the EIN.
Name: Click here to enter text.
Business Name: Click here to enter text.
Taxpayer Identification Number:
Social Security Number: Click here to enter text.
or
Employer Identification Number: Click here to enter text.
Legal Status (check one):
Individual Governmental
Sole Proprietor Nonresident alien
Partnership Estate or trust
Legal Services Corporation Pharmacy (Non-Corp.)
Tax-exempt Pharmacy/Funeral Home/Cemetery (Corp.)
Corporation providing or billing Limited Liability Company medical and/or health care services (select applicable tax classification)
Corporation NOT providing or billing C = corporation medical and/or health care services P = partnership
Signature of Authorized Representative:
Date: Click here to enter a date.
| ADPF35.tmp |
| If yes, please identify each lobbyist and agent, including the name and address below. If you have a lobbyist that does not meet the criteria, then you do not have to disclose the lobbyist’s information. Additional rows may be inserted into the tabl... |
| Yes No. Do you have any contracts, pending contracts, bids, proposals, subcontracts, leases or other ongoing procurement relationships with units of State of Illinois government? |
| If “Yes”, please specify below. Additional rows may be inserted into the table or an attachment in the same format may be provided if needed. |
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