upload_340886_ETIN.pdf
PDF 85 KB Posted
- Contract number
- 27-426DOC-PINCK-P-102839
- Issued by
- Illinois
About this file
This document is a State of Illinois Taxpayer Identification Number (TIN) form completed by the State of Illinois Chief Procurement Office General Services. The form is executed by Ethan Miller on behalf of E&N Service Company, a corporation not providing or billing medical and/or health care services.
The form certifies that E&N Service Company's Employer Identification Number is 92-2046429 and confirms the company's status as a U.S. entity not subject to backup withholding. The authorization is dated August 17, 2026, and is signed by an authorized representative. This form serves as a standard tax identification requirement for state contracting purposes and does not specify particular goods, services, pricing terms, or contract amounts.
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| File | Type | Posted |
|---|---|---|
| upload_340886_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 .