TIN page.docx.pdf
PDF 108 KB Posted
- Attached to
- FY23 IVHC - Smoke/Fire Damper
- Solicitation number
- 23-497DVA-CHICA-B-35828
- Issued by
- Cook County, Illinois
About this file
This document is a Taxpayer Identification Number (TIN) Certification and Disclosure form related to a State of Illinois contract opportunity. The contract is for Smoke/Fire Damper Services (FY23 IVHC - Smoke/Fire Damper) and is being issued by the State of Illinois. The contract requires vendors to provide their taxpayer identification information, including name, business name, and Social Security Number or Employer Identification Number. Vendors must also disclose any existing contracts, pending contracts, bids, proposals, or other procurement relationships with the State of Illinois.
The form does not provide specifics on the quantities, response dates, site visits, or contract term. However, it indicates that additional rows can be inserted into the table or an attachment can be provided if needed to list any relevant procurement relationships with the State.
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Other files
| File | Type | Posted |
|---|---|---|
| standard-terms-and-conditions~17.pdf | ||
| RFQ-Fire damper testing-1.pdf |
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
State of Illinois Chief Procurement Office General Services 3 FORMS B Certifications and Disclosures V.20.1
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: Click here to enter text.
Business Name: Click here to enter text.
Taxpayer Identification Number:
Social Security Number: Click here to enter text.
or Employer Identification Number: Click here to enter text.
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)
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.
| If yes, please identify each lobbyist and agent, including the name and address below. If you have a lobbyist that does not meet the criteria, then you do not have to disclose the lobbyist’s information. Additional rows may be inserted into the tabl... |
| Yes No. Do you have any contracts, pending contracts, bids, proposals, subcontracts, leases or other ongoing procurement relationships with units of State of Illinois government? |
| If “Yes”, please specify below. Additional rows may be inserted into the table or an attachment in the same format may be provided if needed. |
File details come from the government source that posted it. Updated .