Tax ID page.pdf

PDF 70 KB Posted

Attached to
DOO-CVS-Air Brake Simulator-ah
Solicitation number
20-493ISP-OPERA-B-12897
Issued by
Sangamon County, Illinois

About this file

This document is a Taxpayer Identification Number (TIN) certification form for the State of Illinois Chief Procurement Office. It is related to a state and local contract opportunity for the Illinois State Police to purchase one (1) fully functional air brake training simulator display. The contract opportunity is located in Sangamon County, Illinois. The document collects TIN and legal status information from the vendor, which is required for the procurement process.

The document does not provide additional details about the air brake simulator contract opportunity such as the response due date, award date, contract term, or pricing terms. There is also no information provided about any set-asides, incumbent contractors, funding sources, or other salient details.

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Text version

STATE OF ILLINOIS

TAXPAYER IDENTIFICATION NUMBER

State of Illinois Chief Procurement Office General Services 3 FORMS B Certifications and Disclosures V.18.1

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.

File details come from the government source that posted it. Updated .