TAX ID PAGE 1~35.docx
DOCX document 44 KB Posted
- Attached to
- Acad-Dog Food-CB
- Solicitation number
- 26-493ISP-ADMIN-B-50745
- Issued by
- St. Clair County, 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 for use in IFB or RFP solicitations (Version 23.1). The form requires bidders and contractors to provide their correct taxpayer identification information and certify their tax compliance status with the Internal Revenue Service. The form accommodates various entity types including individuals, sole proprietors, partnerships, corporations, limited liability companies, governmental entities, tax-exempt organizations, and specialized entities such as pharmacies and legal services corporations. Bidders must enter their legal name, business name if applicable, and either a Social Security Number or Employer Identification Number, select their appropriate legal status classification, and have an authorized representative sign and date the form.
The form serves as a mandatory documentation requirement for state procurement processes and does not contain information regarding specific contract pricing, set-asides, incumbent contractors, funding sources, or project deliverables. Instead, it functions as a standardized certification document to establish the bidder's tax identification and compliance status prior to contract award. Completion and submission of this form are typically prerequisites for bid consideration in Illinois state and local contracting opportunities.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| standard-illinois-certifications-v-26-2~6.pdf | ||
| B-50745 Dog Food Q and A~2.docx | DOCX document | |
| invitation-for-bid-offer-to-the-state-of-illinois-v-25-3.pdf | ||
| B-50745 Dog Food Q and A_2.docx | DOCX document | |
| part I and part II ISBE B-50838.pdf | ||
| 6634 Change Order Notice 1.pdf | ||
| B-50745 IFB Contract Dog Food 012826.pdf | ||
| B-50745 invitation-for-bid-vendor-instructions-and-requirements.docx | DOCX document | |
| ipg-active-registered-vendor-disclosure-forms-b.docx | DOCX document | |
| vendor-disclosure-formerly-forms-a-v26-2-7-22-2025~4.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 .