TIN form blank~65.docx
DOCX document 30 KB Posted
- Attached to
- Pest Control G0911 Springfield
- Solicitation number
- 27-416CMS-BOPM4-B-53840
- Issued by
- Sangamon County, Illinois
About this file
This is a Tax Identification Number (TIN) form blank document related to a pest control services procurement for the State of Illinois. The form is a template designed for vendors bidding on pest control services at site G0911, located at 601 E. Sangamon Ave, Springfield, Illinois 62702. The document serves as a standard form that bidders must complete and submit as part of their proposal documentation for this contract opportunity.
This procurement is designated exclusively for Small Business Set Aside Program vendors, restricting participation to businesses meeting the applicable small business criteria. The TIN form is a fundamental administrative requirement that vendors must provide to verify their federal tax identification information during the bidding process. No specific pricing terms, contract duration, or other operational details are contained within this blank form document, as it is simply a template for vendors to complete and return with their bids.
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Other files
| File | Type | Posted |
|---|---|---|
| Contract Pest Control G0911 Springfield.docx | DOCX document | |
| standard-illinois-certifications-v-26-2~61.pdf | ||
| Line Item 7 Pricing Instructions~6.docx | DOCX document | |
| Pre-Bid Walk Through Notice-Mandatory B-53840.docx | DOCX document | |
| B-53840 Questions and Answers Pest Control G0911 Springfield.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 .