TIN Page~18.pdf
PDF 494 KB Posted
- Attached to
- IVHM FY 27 Piano Services MBF
- Solicitation number
- 27-497DVA-MANTE-B-51605
- Issued by
- Illinois
About this file
This is a Taxpayer Identification Number (TIN) disclosure form issued by the State of Illinois Chief Procurement Office for General Services, applicable to vendors registering with the state's procurement system. The form is associated with a contract opportunity for professional piano services at a facility for church services, with an execution date of June 30, 2027. All inquiries regarding this opportunity should be directed to travis.kutemeier@illinois.gov, with questions due by June 18, 2026.
The TIN form requires vendors to certify their correct taxpayer identification information and confirm their compliance with Internal Revenue Service backup withholding requirements. Vendors must provide either a Social Security Number for individuals and sole proprietors or an Employer Identification Number for business entities, and must identify their legal status through designated categories including individual, sole proprietor, partnership, corporation, limited liability company, or tax-exempt organization. For corporations providing medical and health care services, an IRS acceptance letter (CP261 or CP277) must be attached. This disclosure is a standard requirement for vendors seeking to establish or maintain active registered vendor status with the State of Illinois.
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Other files
| File | Type | Posted |
|---|---|---|
| IVHM Piano Service Bidding Documentation~1.docx | DOCX document |
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
State of Illinois Chief Procurement Office for General Services 4 IPG Active Registered Vendor Disclosure V.23.1
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:
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)
Corporation NOT providing or billing C = corporation medical and/or health care services P = partnership
Signature of Authorized
Representative: Date:
File details come from the government source that posted it. Updated .