TIN Page F17 6.29.2026.pdf
PDF 171 KB Posted
- Contract number
- 26-402AGE-FINAD-P-98274
- Issued by
- Illinois
About this file
This is a State of Illinois Taxpayer Identification Number form completed by Dan Cepa, authorized representative of Fresh Coast Promotions dba Imprintable Memories. The document serves as a tax certification form required for state and local contracting purposes, establishing the taxpayer's identification credentials and legal status for doing business with the State of Illinois.
The entity is registered as a Corporation NOT providing or billing medical and/or health care services, with an Employer Identification Number of 84-3443234. The form certifies that the taxpayer is not subject to backup withholding by the Internal Revenue Service and is a U.S. person. The document was signed and dated June 29, 2026, by the authorized representative. This form does not contain information regarding specific goods, services, pricing, contract amounts, or renewal terms, as it is exclusively a tax identification and certification document required as a prerequisite for state contracting eligibility.
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Other files
| File | Type | Posted |
|---|---|---|
| Federal W-9 Form~16 6.29.2026.pdf |
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
State of Illinois 1 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: Dan Cepa
Business Name: Fresh Coast Promotions dba Imprintable Memories
Taxpayer Identification Number:
Social Security Number: Click here to enter text.
or
Employer Identification Number: 84-3443234
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. 6/29/2026
File details come from the government source that posted it. Updated .