TIN form blank~52.docx
DOCX document 30 KB Posted
- Attached to
- Snow removal L6360 Anna
- Solicitation number
- 26-416CMS-BOPM4-B-52230
- Issued by
- Tazewell County, Illinois
About this file
This is a Tax Identification Number (TIN) form blank related to a snow removal services contract opportunity with the State of Illinois. The contract, identified as L6360, covers snow removal services at 108 Denny Drive, Anna, Illinois 62906. The file appears to be a template document designed for vendors to complete and submit as part of their bid package for this contract opportunity.
The contract is set-aside exclusively for SBSA (Small Business Set-Aside) vendors that are registered in the IPG (Illinois Procurement Gateway) at the time of bid submission. This restriction limits eligibility to small business enterprises meeting Illinois state criteria and ensures compliance with state small business contracting goals. The TIN form itself is a standard documentation requirement used to verify vendor identity and tax status during the bidding and contracting process.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| L6360-Anna Ariel Photo- Snow removal 4.22.26.pdf | ||
| B-52230 Snow Removal Contract L6360 Anna REVISED.docx | DOCX document | |
| standard-illinois-certifications-v-26-2~36.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 .