Taxpayer Form V.15.2.docx
DOCX document 136 KB Posted
- Attached to
- 99s014 Prismatic Sheeting Cutter
- Solicitation number
- 19-494DOT-FINAD-B-3548
- Issued by
- Illinois
About this file
This document is a Taxpayer Identification Number form for the State of Illinois Chief Procurement Office General Services. It requires the completion of the taxpayer's name, business name, Social Security Number or Employer Identification Number, and legal status. The form is likely associated with a state and local contract opportunity identified as 99s014 Prismatic Sheeting Cutter, located in the state of Illinois. Details such as quantities, response dates, due dates, site visits, bidder's meetings, award dates, and contract term are not provided in this document.
The document outlines pricing and payment terms, requiring the taxpayer to certify that the provided Taxpayer Identification Number is correct and that they are not subject to backup withholding. Additional information regarding set asides, incumbents, current environment, funding requirements and sources, and other salient details are not included in this particular document.
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Other files
| File | Type | Posted |
|---|---|---|
| Standard Certifications V.18.1~1.docx | DOCX document | |
| Department specific terms equipment installed and training.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 1 IFB or RFP Solicitation: Forms A: Taxpayer Identification Number V.15.2a
File details come from the government source that posted it. Updated .