Taxpayer Identification number form.pdf
PDF 70 KB Posted
- Solicitation number
- 20-493ISP-FOREN-B-13613
- Issued by
- Cook County, Illinois
About this file
This document is a Taxpayer Identification Number form from the State of Illinois Chief Procurement Office. It requests the name, business name, and taxpayer identification number (Social Security Number or Employer Identification Number) of the respondent, as well as their legal status. The related state and local contract opportunity is a three-year repair and maintenance agreement for 16 Life Technologies Real Time qPCR 7500 instruments, 7 3500 CE instruments, and 5 3500 XL CE instruments used by the Illinois State Police Forensic Science Command Laboratories.
The contract opportunity does not provide any details on pricing, set asides, incumbents, funding sources, or other salient information. The document focuses solely on the requirement to complete the Taxpayer Identification Number form as part of the procurement process for this multi-year service agreement.
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Other files
| File | Type | Posted |
|---|---|---|
| B13613 Signed NOA.pdf | ||
| Forms A Section V.18.1~7.doc | DOC document | |
| Standard Certifications V.18.1~7.doc | DOC document | |
| Forms B Section V.20.1~11.docx | DOCX document | |
| R-54550 IFB~1.docx | DOCX document | |
| Attachment - Notice of Electronic Submission Only.pdf |
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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 .