TAX ID PAGE 1~24.docx
DOCX document 43 KB Posted
- Contract number
- 26-493ISP-FOREN-P-87820
- Issued by
- Illinois
About this file
This document is a Taxpayer Identification Number form issued by the State of Illinois, specifically from the Chief Procurement Office of General Services. The form is designed for collecting essential tax and identification information from vendors or contractors seeking to do business with the state government. It provides a standardized template for entities to declare their legal status, taxpayer identification number, and other key administrative details required for government contracting and payment processes.
The form allows for multiple legal entity types to complete the document, including individuals, sole proprietors, partnerships, corporations, limited liability companies, and various governmental and tax-exempt organizations. While no specific contract, goods, or services are detailed in this document, it serves as a critical administrative prerequisite for vendor registration and participation in state procurement processes. The form requires detailed information such as the entity's name, business name, Social Security Number or Employer Identification Number, and requires an authorized representative's signature to validate the submitted information.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| B-49475 Bid Amendment 2 QA 1.docx | DOCX document | |
| B-49475 FSC-C Snow Removal Specs for Vendors.pdf | ||
| Standard Illinois Certifications v.26.2.pdf | ||
| standard-terms-and-conditions 23.2~77.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 .