Taxpayer ID Number Page~67.docx
DOCX document 44 KB Posted
- Contract number
- 26-551HDA-FINAN-P-87735
- Issued by
- Illinois
About this file
This document is a Taxpayer Identification Number form from the State of Illinois, specifically issued by the Chief Procurement Office of General Services. The form is part of a standard procurement process and appears to be related to an IFB (Invitation for Bid) or RFP (Request for Proposal) solicitation, with the purpose of collecting essential tax and identification information from a potential contractor or vendor.
The form provides a template for various entity types to provide their taxpayer identification details, including options for individuals, sole proprietors, partnerships, corporations, and limited liability companies. It requires disclosure of name, business name, Social Security Number or Employer Identification Number, and legal status. While the specific contract details are not fully populated in this document, the form is designed to capture critical tax and legal information necessary for government contracting processes, with provisions for different business structures and tax classifications.
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Other files
| File | Type | Posted |
|---|---|---|
| Scope of Services - Compensation Study 25-26 SPSB~1.docx | DOCX document | |
| Standard Illinois Certifications v.26.2~1.pdf | ||
| Standard terms and conditions~38.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 .