TAX ID PAGE 1~29.docx
DOCX document 44 KB Posted
- Attached to
- 911-Adapters fuses-CRB
- Solicitation number
- 26-493ISP-ADMIN-B-49858
- Issued by
- Illinois
About this file
This is a Taxpayer Identification Number (TIN) form issued by the State of Illinois Chief Procurement Office under the General Services division, applicable to Invitations for Bid (IFB) or Request for Proposal (RFP) solicitations. The form certifies the taxpayer identification information of bidders and vendors participating in state procurement opportunities. It requires respondents to provide their correct taxpayer identification number and confirm they are not subject to backup withholding by the Internal Revenue Service, or alternatively, provide documentation of their backup withholding status. The form accommodates various entity types including individuals, sole proprietors, partnerships, corporations, limited liability companies, tax-exempt organizations, and specialized entities such as pharmacies and legal services corporations.
The form requires vendors to enter their legal name, business name or doing-business-as designation, and either a Social Security Number for individuals and sole proprietors or an Employer Identification Number for business entities. Respondents must select their legal status category from the provided options and have an authorized representative sign and date the certification. Corporations that provide or bill for medical and/or health care services must attach IRS acceptance letters (Form CP261 or CP277) and indicate their tax classification as either a C corporation or partnership. This form serves as a prerequisite documentation requirement for all vendors submitting bids or proposals to the State of Illinois.
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Other files
| File | Type | Posted |
|---|---|---|
| standard-terms-and-conditions 23.2~82.pdf | ||
| Vehicle Adaptors_Fuses Bid Specifications~6.docx | DOCX document | |
| Invitation for Bid Vendor Instructions and Requirements B-49876~1.docx | DOCX document |
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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 .