TAX ID PAGE 1~21.docx
DOCX document 43 KB Posted
- Attached to
- Logistics 11th Floor Project SPSSC - SM
- Solicitation number
- 25-493ISP-ADMIN-B-48747
- Issued by
- Illinois
About this file
The document is a Taxpayer Identification Number form from the State of Illinois, specifically from the Chief Procurement Office of General Services. This tax identification form is designed for vendors, contractors, or service providers to provide their legal and tax information when participating in a state procurement process. The form requires detailed information about the entity's legal status, including options for individuals, sole proprietors, partnerships, corporations, limited liability companies, and various other entity types.
The form instructs the taxpayer to provide their name, business name, Social Security Number (SSN) or Employer Identification Number (EIN), and to certify their tax status, including exemption from backup withholding and U.S. person/resident status. The document includes multiple check boxes for different legal statuses, with specific instructions for various entity types such as single-member LLCs, corporations, and partnerships. An authorized representative must sign and date the form, which appears to be part of a solicitation process (IFB or RFP) for the State of Illinois procurement system.
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Other files
| File | Type | Posted |
|---|---|---|
| standard-illinois-certifications-v.23.1 1~28.docx | DOCX document | |
| standard-terms-and-conditions 23.2~74.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 .