TIN form blank~48.docx
DOCX document 29 KB Posted
- Attached to
- Snow Removal L4887 LaSalle
- Solicitation number
- 26-416CMS-BOPM4-B-51457
- Issued by
- Lee County, Illinois
About this file
This is a Taxpayer Identification Number (TIN) form required by the State of Illinois for a Snow Removal services contract (L4887) located at 905 Second Street, LaSalle, Illinois 61301. The form serves as a certification document for bidders to provide their correct taxpayer identification information and confirm their status regarding backup withholding requirements. The form accommodates various entity types including individuals, sole proprietors, partnerships, corporations, limited liability companies, and other business structures, each with specific instructions for completing the name and identification number fields. Bidders must select their legal status from the provided checkboxes and provide either a Social Security Number or Employer Identification Number, with corporations required to attach IRS acceptance letters (CP261 or CP277) for validation.
This contract opportunity is set-aside exclusively for Small Business Set-Aside (SBSA) vendors registered in the Illinois Procurement Gateway (IPG) at the time of bid submission. The form requires the signature of an authorized representative and the submission date to complete the certification process. Prospective bidders must ensure accurate completion of all required fields and proper documentation of their entity status to maintain eligibility for this snow removal services contract opportunity in LaSalle, Illinois.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Contract Snow Removal L4887 LaSalle SBSA No Subs 07-03-25~2.docx | DOCX document | |
| standard-illinois-certifications-v-26-2~28.pdf | ||
| Photos L4887 905 2nd St LaSalle Snow Removal~1.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 .