upload_337551_ETIN.pdf
PDF 85 KB Posted
- Contract number
- 27-426DOC-EMOLI-P-102291
- Issued by
- Illinois
About this file
Document Summary
This is a State of Illinois Taxpayer Identification Number (TIN) certification form completed by the State of Illinois Chief Procurement Office General Services division. The form identifies E&N Service Company, a corporation, as the contracting entity, with Ethan Miller listed as the authorized representative. The company's Employer Identification Number is 92-2046429. The form was executed on August 17, 2026.
The document serves as a federal tax compliance certification in which the contractor certifies that the provided EIN is correct, that the entity is not subject to backup withholding by the Internal Revenue Service, and that it is a U.S. person. The legal status is identified as a Corporation NOT providing or billing medical and/or health care services. This certification form is a standard prerequisite requirement for state procurement transactions and does not contain information regarding specific goods, services, pricing, contract terms, or renewal conditions.
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Other files
| File | Type | Posted |
|---|---|---|
| 27EMO0195 BOA.pdf | ||
| upload_337551_BOA.pdf |
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Text version
STATE OF ILLINOIS
TAXPAYER IDENTIFICATION NUMBER
State of Illinois Chief Procurement Office General Services 10 Taxpayer Identification Number V.23.2
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: Ethan Miller
Business Name: E&N Service Company Taxpayer Identification Number:
Social Security Number:
or
Employer Identification Number: 92-2046429
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)
X Corporation NOT providing or billing C = corporation medical and/or health care services P = partnership
Signature of Authorized Representative:
Date: August 17, 2026
File details come from the government source that posted it. Updated .