Taxpayer Form V.15.2~15.docx
DOCX document 136 KB Posted
- Attached to
- Aluminum Edge Trim for Highway Signs
- Solicitation number
- 21-494DOT-FINAD-B-16076
- Issued by
- St. Clair County, Illinois
About this file
This document is a State of Illinois Taxpayer Identification Number form related to a state and local contract opportunity for the firm quantity purchase of aluminum edge trim for highway signs by the Illinois Department of Transportation. The form requires the contractor to provide their name, business name, taxpayer identification number, and legal status. The related state and local contract opportunity seeks bids for this firm quantity purchase, but does not provide details on quantities, response dates, award dates, or the contract term.
The document does not include information on pricing terms, set asides, incumbents, funding requirements and sources, or other salient details about the contract opportunity. It focuses solely on collecting the contractor's taxpayer identification information, which is a standard requirement for state and local government procurement.
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Other files
| File | Type | Posted |
|---|---|---|
| Aluminum Edge Trim for Highway Signs rev 7-7.docx | DOCX document | |
| Standard Certifications V.18.1~20.docx | DOCX document | |
| End Cap Diagram.pdf |
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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 .