TIN form blank~58.docx
DOCX document 30 KB Posted
- Attached to
- 5 Day Janitorial L6277 Marion
- Solicitation number
- 27-416CMS-BOPM4-B-53252
- Issued by
- Washington County, Illinois
About this file
This is a Taxpayer Identification Number (TIN) form for the State of Illinois, required as part of the procurement process for the 5 Day Janitorial services contract at location L6277 in Marion, Illinois. The form certifies the bidder's correct taxpayer identification number and confirms the bidder is not subject to backup withholding by the Internal Revenue Service. The form accommodates various entity types including individuals, sole proprietorships, partnerships, corporations, limited liability companies, and tax-exempt organizations, with specific instructions for each classification regarding how to report the entity name and corresponding identification number or employer identification number.
The TIN form includes checkboxes for legal status designation, with the form indicating a Corporation NOT providing or billing medical and/or health care services as the selected category. Bidders must provide their name, business name, taxpayer identification number or Social Security number, and authorization signature with date. This documentation is a standard requirement for state contracting and ensures compliance with Illinois tax identification and withholding regulations prior to contract award.
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Other files
| File | Type | Posted |
|---|---|---|
| Pre-Bid Walk Through Notice 5 Day Janitorial L6277 Marion~1.docx | DOCX document | |
| Contract 5 Day Janitorial L6277 Marion~2.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:
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 .