TAX ID PAGE 1~11.docx
DOCX document 43 KB Posted
- Attached to
- DJS - PAB - Peak Performance - SM
- Solicitation number
- 25-493ISP-ADMIN-B-46793
- Issued by
- Illinois
About this file
The document is a State of Illinois Taxpayer Identification Number form from the Chief Procurement Office of General Services, designed to collect essential tax and business identification information for potential vendors or contractors. The form requires detailed identification data, including the taxpayer's name, business name, Social Security Number or Employer Identification Number, and legal status classification.
The form provides comprehensive instructions for different types of business entities, including individuals, sole proprietors, single-member LLCs, corporations, and partnerships, outlining specific requirements for completing the document. Taxpayers must certify their identification number's accuracy, confirm their backup withholding status, and provide a signature from an authorized representative. The form includes multiple legal status options such as governmental, partnership, corporation, tax-exempt entity, and various medical service provider classifications, enabling precise identification of the business entity seeking to engage with the State of Illinois procurement process.
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Other files
| File | Type | Posted |
|---|---|---|
| standard-illinois-certifications-v.23.1 1~19.docx | DOCX document | |
| standard-terms-and-conditions 23.2~64.pdf |
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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 .