Taxpayer Identification Page~9.docx
DOCX document 27 KB Posted
- Attached to
- IDOC- 7. 5oz Kelly Green Twill
- Solicitation number
- 26-426DOC-CENTR-B-51587
- Issued by
- Illinois
About this file
This is a Taxpayer Identification form used by the State of Illinois Chief Procurement Office for General Services contracting purposes. The document is designed to collect critical identification information from prospective contractors bidding on state contracts, including those administered by agencies such as the Illinois Department of Corrections (IDOC), which is procuring 7.5oz Kelly Green Twill fabric for Centralia Correctional Center to manufacture jumpsuits and coats for individuals in custody. The form requires bidders to provide their legal business name, taxpayer identification number (either Social Security Number or Employer Identification Number), and their legal business status, which includes options for individuals, sole proprietors, partnerships, corporations, limited liability companies, and various specialized entities such as tax-exempt organizations and legal services corporations.
The form serves as a prerequisite for contract bidding and requires authorized representatives to certify that the taxpayer identification number provided is correct and that the bidder is not subject to backup withholding by the Internal Revenue Service. The document includes specific instructions for different entity types, such as requiring sole proprietors to list both owner and business names, and mandating that corporations provide IRS acceptance letters (CP261 or CP277). This standardized form is part of the State of Illinois' procurement compliance requirements and must be completed and signed by an authorized representative prior to contract award or execution.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Approved SBSA Waiver - Kelly Green Twill - B51587~1.pdf | ||
| Standard-terms-and-conditions~3.pdf | ||
| Vendor question~1.docx | DOCX document | |
| Unsigned Contract-Centralia Kelly Green Twill - B-51587.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: ___________________________ State of Illinois Chief Procurement Office for General Services Contract V.23.2
File details come from the government source that posted it. Updated .