TIN Page~7.pdf
PDF 494 KB Posted
- Attached to
- FY 27 IVHM Preemployment Physicals
- Solicitation number
- 27-497DVA-MANTE-B-54141
- Issued by
- Illinois
About this file
This is a Tax Identification Number (TIN) page document related to the Illinois FY 27 IVHM Preemployment Physicals contract opportunity. The contract seeks a vendor to provide preemployment physicals, weightlifting assessments, respiratory fit testing, and drug screening services. The vendor must maintain a facility within a 20-mile radius of the specified location at the time of bid submission. No subcontracting is permitted under this contract. All questions regarding the opportunity must be submitted to travis.kutemeier@illinois.gov by October 1, 2026.
The document appears to contain Tax Identification Number information relevant to vendor qualification and registration requirements for the bidding process. Additional details regarding pricing terms, contract duration, funding amounts, and specific service delivery requirements would be found in the complete solicitation documents and scope of work.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| IVHM Preemployment Physicals Bidding Documentation~3.docx | DOCX document | |
| standard-terms-and-conditions v.23.2.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .