TIN Page~18.pdf
PDF 494 KB Posted
- Attached to
- IVHM FY 27 Piano Services MBF
- Solicitation number
- 27-497DVA-MANTE-B-53236
- Issued by
- Illinois
About this file
This is a Taxpayer Identification Number (TIN) disclosure form from the State of Illinois Chief Procurement Office for General Services, used for vendor registration in the Illinois Procurement Gateway (IPG) system. The form is associated with a contract opportunity for professional piano services at a facility for church services under the Illinois Veterans Home at Manteno (IVHM) for fiscal year 2027. The service period extends from execution through June 30, 2027, with all inquiries directed to travis.kutemeier@illinois.gov by the July 20, 2026 deadline.
The TIN disclosure form requires vendors to provide either a Social Security Number (for individuals and sole proprietors) or an Employer Identification Number (for entities such as partnerships, corporations, limited liability companies, and other organizational structures). Vendors must certify their correct taxpayer identification and confirm they are either exempt from backup withholding or have not been notified by the IRS of backup withholding requirements. The form includes checkboxes for vendors to indicate their legal status, including options for individual, sole proprietor, partnership, corporation, limited liability company, tax-exempt organization, and entities providing medical or health care services. This documentation is a standard requirement for all vendors seeking to conduct business with the State of Illinois.
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Other files
| File | Type | Posted |
|---|---|---|
| IVHM Piano Service Bidding Documentation~2.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 .