TIN Page~5.pdf
PDF 494 KB Posted
- Attached to
- IVHM FY 27 Fire Alarm Inspections
- Solicitation number
- 27-497DVA-MANTE-B-53366
- Issued by
- Kane County, 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, designed for vendors registering with the state's procurement system. The form requires vendors to provide their correct taxpayer identification number and certify their compliance with backup withholding requirements under Internal Revenue Service regulations. Vendors must supply either a Social Security Number for individuals and sole proprietors or an Employer Identification Number for business entities, along with their legal business structure classification. The form accommodates various entity types including individuals, governmental entities, sole proprietorships, partnerships, estates or trusts, corporations, limited liability companies, and specialized entities such as pharmacies and funeral homes. For corporations providing medical or health care services, vendors must attach IRS acceptance letters (CP261 or CP277) to verify proper entity registration.
The related contract opportunity is for the Illinois Department of Veterans' Homes (IVHM) Fire Alarm Inspections for fiscal year 2027, requiring vendors to provide labor and materials for inspection and maintenance of facility sprinkler systems. The contract term extends from execution through June 30, 2027, with no subcontracting permitted. All vendor questions must be submitted to travis.kutemeier@illinois.gov by August 3, 2026. This TIN form serves as a prerequisite registration document that prospective bidders must complete and certify as part of the vendor registration process before submitting proposals for this state contract opportunity.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| standard-illinois-certifications-v.23.1~31.docx | DOCX document | |
| IVHM Fire Alarm Bidding Documentation FINAL~4.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 .