TIN page v.23.1~9.docx
DOCX document 30 KB Posted
- Attached to
- SP Paper Cutter
- Solicitation number
- 24-557THA-ADMIN-B-41709
- Issued by
- Dupage County, Illinois
About this file
This document is a Taxpayer Identification Number (TIN) certification form for the State of Illinois. It requires the contractor to provide their name, business name, and taxpayer identification number, either a Social Security Number or an Employer Identification Number. The contractor must indicate their legal status, such as individual, sole proprietor, partnership, or corporation, and certify that the information provided is correct and that they are not subject to backup withholding. The form must be signed by an authorized representative and dated.
The document outlines the requirements for providing tax identification information to the State of Illinois for the purpose of establishing a contractual relationship. It does not contain any information about a specific contract opportunity, project details, pricing, or other salient details typically found in a solicitation or bid document.
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Other files
| File | Type | Posted |
|---|---|---|
| 24-0033 RFQ Paper Cutter 2.pdf | ||
| Standard Terms and Conditions 23.2~25.pdf |
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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: 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.
State of Illinois Chief Procurement Office for General Services 3Taxpayer Identification Number (TIN) V.23.1
File details come from the government source that posted it. Updated .