TAX ID PAGE 1.docx
DOCX document 43 KB Posted
- Attached to
- 911 - Clay City Mason Tower - SM
- Solicitation number
- 25-493ISP-OPERA-B-45611
- Issued by
- Madison County, Chicago City, Illinois
About this file
This document is a Taxpayer Identification Number (TIN) form for the State of Illinois. It is to be used by an individual, sole proprietor, limited liability company (LLC), partnership, corporation, tax-exempt organization, or other legal entity to provide their taxpayer identification number, which can be either a Social Security Number (SSN) or an Employer Identification Number (EIN). The form certifies that the taxpayer identification number provided is correct and that the entity is not subject to backup withholding. This information is required for all state and local contract opportunities in Illinois.
The document outlines the various legal statuses that can be selected, including individual, governmental, sole proprietor, partnership, corporation, and LLC. It also specifies the information that must be provided based on the selected legal status, such as the name of the individual or business, the taxpayer identification number, and the authorized representative's signature and date.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| R-244439 Clay City Mason Tower Mimomax Specs~1.pdf | ||
| B-45611 Bid Amendment 3 QA 1~2.docx | DOCX document | |
| standard-illinois-certifications-v.23.1 1~9.docx | DOCX document | |
| standard-terms-and-conditions 23.2~52.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
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.
State of Illinois Chief Procurement Office General Services 21 IFB or RFP Solicitation: Forms A: Taxpayer Identification Number V.23.1
File details come from the government source that posted it. Updated .