TIN Page~3.pdf
PDF 494 KB Posted
- Solicitation number
- 27-497DVA-MANTE-B-53477
- Issued by
- Kane County, Illinois
About this file
This is a Taxpayer Identification Number (TIN) disclosure form from the State of Illinois Chief Procurement Office for General Services, required for vendor registration in the Illinois Procurement Gateway (IPG) system. The form is associated with the IVHM FY 27 Building Automation System Maintenance contract opportunity, which involves providing labor and materials for the maintenance of a facility's building automation system. The contract execution date is June 30, 2027, with all technical questions required to be submitted to travis.kutemeier@illinois.gov by July 30, 2026.
The TIN form requires vendors to provide their correct taxpayer identification number and certify their tax status, confirming they are not subject to backup withholding by the Internal Revenue Service. Vendors must indicate their legal status by selecting from options including individual, sole proprietor, partnership, corporation, limited liability company, or other entity types, and provide corresponding identification documentation such as an EIN or SSN. For corporations providing medical and health care services, IRS acceptance letters (CP261 or CP277) must be attached. This form is a mandatory component of the vendor registration and qualification process for State of Illinois procurement opportunities.
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Other files
| File | Type | Posted |
|---|---|---|
| IVHM BAS System Bidding Documentation~3.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 .