Taxpayer ID Number Page~61.docx
DOCX document 38 KB Posted
- Attached to
- Auditboard 26-27 Small Purchase
- Solicitation number
- 26-551HDA-LEGAL-B-51213
- 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 for use in IFB or RFP solicitations. The form requires bidders to provide their correct taxpayer identification information and certify that they are not subject to backup withholding by the Internal Revenue Service. Bidders must complete the form with their legal name, business name if applicable, and either their Social Security Number or Employer Identification Number depending on their business structure. The form includes checkboxes for bidders to indicate their legal status, including options for individuals, sole proprietors, partnerships, corporations, limited liability companies, governmental entities, nonresident aliens, estates or trusts, tax-exempt organizations, and entities providing medical or health care services.
The form serves as a standard compliance document required for state procurement solicitations and must be signed by an authorized representative with the date of signature. This particular form (Version 15.2a) is applicable to the Auditboard 26-27 Small Purchase contract opportunity issued by the State of Illinois. No specific pricing terms, contract amounts, or project scope details are provided within this form, as it functions solely as a tax identification verification and certification document for potential bidders to complete as part of the solicitation process.
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Other files
| File | Type | Posted |
|---|---|---|
| Standard Certifications Illinois v.26.2.pdf | ||
| Standard Terms and Conditions V.23.2.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:
Business Name:
Taxpayer Identification Number:
Social Security Number:
or Employer Identification Number:
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:
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 .