TAX ID PAGE 1~27.docx
DOCX document 43 KB Posted
- Attached to
- DFS-SESC-Drones--CB
- Solicitation number
- 26-493ISP-OPERA-B-50011
- Issued by
- Illinois
About this file
This is a Taxpayer Identification Number (TIN) form required by the State of Illinois Chief Procurement Office, General Services division, for use in IFB or RFP solicitations. The form serves as a certification document where bidders must provide their correct taxpayer identification information and confirm their compliance with backup withholding requirements as established by the Internal Revenue Service. Bidders are required to complete the form by entering their legal name, business name (if applicable), and either a Social Security Number or Employer Identification Number depending on their entity type. The form includes checkboxes for various legal statuses including individual, sole proprietor, partnership, corporation, limited liability company, and tax-exempt entities, with additional classifications for entities providing medical or health care services. An authorized representative must sign and date the completed form before submission.
The form contains no pricing terms, contract amounts, set-asides, or funding information, as it functions solely as a compliance and identification document required during the procurement process. Bidders must select their appropriate legal status classification and provide supporting documentation as specified, such as IRS acceptance letters for certain corporate structures. This form is a mandatory component of state procurement procedures and does not establish contract terms or conditions.
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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 .