TIN Page~3.pdf
PDF 494 KB Posted
- Solicitation number
- 27-497DVA-MANTE-B-52911
- Issued by
- Illinois
About this file
This is a Taxpayer Identification Number (TIN) form issued by the State of Illinois Chief Procurement Office for General Services as part of their Active Registered Vendor Disclosure process (Version 23.1). The form is associated with the IVHM FY 27 Building Automation System Maintenance contract opportunity, which requires vendors to provide labor and materials for the maintenance of facility building automation systems. The contract execution date is June 30, 2027, with all vendor questions due to travis.kutemeier@illinois.gov by June 22, 2026.
The TIN form serves as a vendor registration and certification document, requiring respondents to provide their correct taxpayer identification number and certify their tax compliance status. Vendors must indicate their legal status—whether they are individuals, sole proprietors, partnerships, corporations, limited liability companies, or other entity types—and provide corresponding identification documentation such as Social Security Numbers or Employer Identification Numbers. For corporations, vendors must attach IRS acceptance letters (CP261 or CP277). This form is a prerequisite for vendors seeking to register with Illinois's procurement system and bid on state contracting opportunities.
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Other files
| File | Type | Posted |
|---|---|---|
| IVHM BAS System 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 .