TIN Page - Blank.docx

This is a Taxpayer Identification Number (TIN) certification form issued by the State of Illinois Chief Procurement Office under the General Services division. The form is a blank template designed for vendors and contractors bidding on state contracts, including the 2026 Road & Bridge Laws of Illinois FY27 REBID solicitation. The form requires vendors to certify their correct taxpayer identification number and confirm they are not subject to backup withholding by the Internal Revenue Service. Vendors must provide their legal name, business name, and appropriate identification number based on their entity type, which may include a Social Security Number for individuals or sole proprietors, or an Employer Identification Number for partnerships, corporations, limited liability companies, and other business entities. The form includes checkboxes for vendors to identify their legal status, ranging from individual and sole proprietor to corporation, partnership, and tax-exempt organization, with specific instructions for different entity classifications such as pharmacies, legal services corporations, and medical and health care service providers.

The TIN form serves as a mandatory documentation requirement for all vendors participating in Illinois state and local contract opportunities through the BidBuy procurement system. Completion and submission of this certification is necessary before a vendor can be considered for award on state contracts. The form requires an authorized representative's signature and date to validate the certification. This form represents a standard compliance and verification document in the Illinois procurement process, ensuring that all bidders provide accurate taxpayer identification information for payment processing and tax reporting purposes.