TIN form blank~41.docx
DOCX document 29 KB Posted
- Attached to
- 5 Day Janitorial D0700 Effingham
- Solicitation number
- 26-416CMS-BOPM4-B-49916
- Issued by
- Edgar County, Illinois
About this file
This is a Taxpayer Identification Number (TIN) form for the State of Illinois, related to a 5-Day Janitorial contract opportunity (D0700) in Effingham. The form serves as a certification document required from potential contractors and vendors engaging with the State of Illinois. The document requires respondents to provide their correct taxpayer identification number and certify their compliance with Internal Revenue Service backup withholding requirements. Bidders must complete the form by providing their legal name, business name if applicable, and either a Social Security Number or Employer Identification Number. The form requires selection of legal status from multiple options including individual, sole proprietor, partnership, corporation, limited liability company, governmental entity, and tax-exempt organization, with specific instructions provided for each entity type.
The form includes signature and date fields for an authorized representative and does not specify pricing terms, set-asides, incumbent information, or other financial details. This is a standard compliance and identification document that bidders must submit as part of their response to the State of Illinois contract opportunity. No specific contract award dates, term lengths, renewal options, or funding amounts are indicated on this form, as it functions solely as a tax identification certification requirement for vendor qualification and payment processing purposes.
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Other files
| File | Type | Posted |
|---|---|---|
| 5 Day Janitorial Contract D0700 Effingham~3.docx | DOCX document | |
| Mandatory Walk-Through Instructions - 5 Day Janitorial D0700 Effingham.docx | DOCX document | |
| Standard Illinois Certifications v.26.2~15.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) | ||||
| |X| 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 .