TIN form blank~53.docx
DOCX document 30 KB Posted
- Attached to
- Snow Removal G0800 Metamora
- Solicitation number
- 26-416CMS-BOPM4-B-52363
- Issued by
- Wabash County, Illinois
About this file
This is a Taxpayer Identification Number (TIN) form for the State of Illinois, applicable to the Snow Removal G0800 contract opportunity in Metamora, Illinois. The form serves as a certification document requiring bidders to provide their correct taxpayer identification information and confirm their tax compliance status. Bidders must declare whether they are exempt from backup withholding or have received IRS notification regarding their withholding status, and certify their status as U.S. persons or U.S. resident aliens.
The form accommodates various entity types, including individuals, sole proprietors, partnerships, corporations, limited liability companies, and tax-exempt organizations. Bidders must provide their legal name, business name, and appropriate taxpayer identification number—either a Social Security Number for individuals and sole proprietors or an Employer Identification Number for business entities. Corporations providing or billing for medical and/or health care services must attach IRS acceptance letters (CP261 or CP277). The Snow Removal G0800 contract at 1265 Lourdes Road, Metamora, Illinois is set-aside for Small Business Set-Aside (SBSA) vendors registered in the Illinois Procurement Gateway (IPG) at the time of bid submission.
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Other files
| File | Type | Posted |
|---|---|---|
| Contract Snow Removal G0800 Metamora B-52363.docx | DOCX document | |
| standard-illinois-certifications-v-26-2~37.pdf | ||
| Ariel Photo 1265 Lourdes Rd Metamora IL.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 .