upload_E-TIN64~6.pdf
PDF 85 KB Posted
- Contract number
- 27-426DOC-ROBIN-P-100037
- Issued by
- Illinois
About this file
This is a State of Illinois Taxpayer Identification Number (TIN) form completed by the Chief Procurement Office General Services Division. 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, with an Employer Identification Number of 92-2046429. The document was signed and dated July 6, 2026.
The form serves as certification that E&N Service Company has provided accurate taxpayer identification information and is not subject to backup withholding by the Internal Revenue Service. The company confirms its status as a U.S. entity and acknowledges compliance with federal tax reporting requirements. No specific goods, services, pricing terms, or contractual amounts are detailed in this taxpayer identification document, as it functions solely as a prerequisite administrative submission for state procurement purposes.
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Other files
| File | Type | Posted |
|---|---|---|
| 27ROB0077 BOA to be filled.docx | DOCX document | |
| upload_331066_BOA.pdf | ||
| Standard Terms and Conditions- V23.2~4.pdf | ||
| notice of electronic submission only rev 23-1~2.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: July 6, 2026
File details come from the government source that posted it. Updated .