Type of Business Entity. (check one) x C-Corporation ¨ S-Corporation ¨ Partnership ¨ Sole Proprietorship ¨ Tax Exempt Organization ¨ Limited Liability Company (LLC) ¨ Limited Liability Partnership (LLP) ¨ Other (must be a legal entity recognized under Federal income tax laws)
Type of Business Entity. 2.2.4 Business Address:
Type of Business Entity. Corporation
Type of Business Entity. Sole proprietorship (Provide full name and address of owner): Limited Partnership (Provide full name and address of all partners): General Partnership (Provide full name and address of all partners): Limited Liability Company (Provide full name and address of all managing members): Corporation (Provide full name and address of all officers): Doing Business As: If Applicable (Note: This is the name that appears on your invoices but is not used as your reporting name.) Name and Position of Person Completing this Certificate: Physical Business Address: Primary Correspondence Address (If different from physical address): Number of Employees: Are all Employees Who Work in the United States Eligible for Employment in the United States? Under penalties of perjury, I declare on behalf of the Contractor listed above that to the best of my knowledge and based upon reasonable inquiry, each and every one of the Contractor’s employees who work in the United States are eligible for employment in the United States as required by the Federal Immigration Reform and Control Act of 1986 and Section 40.1-11.1 of the Code of Virginia. I further declare on behalf of the Contractor that it shall use due care and diligence to ensure that all employees hired in the future who will work in the United States will be eligible for employment in the United States. I affirm that the information provided herein is true, correct, and complete. Sworn this ____ day of ________________, 201_ on behalf of ________________________as evidenced by the following signature and seal: Name of Contractor: __________________________________ Printed Name of Signatory:___________________________________ Signature:________________________________________________ Date:_______________ COMMONWEALTH OF VIRGINIA: CITY/COUNTY OF____________________________, to-wit: The foregoing instrument was acknowledged before me this ___ day of ______________, 201__, by _______________________. _________________________ Notary Public Registration No.:_________________ My commission expires:___________ End of Section D ecember 2010 102 - 27 Project Title Date Owner
Type of Business Entity. Check one (attach additional pages to this form if the space below is not adequate): Sole Proprietorship—provide full name and address of owner Limited Partnership—provide full name and address of all partners General Partnership—provide full name and address of all partners Limited-Liability Corporation—provide full name and address of all managing members Corporation—provide full name and address of all officers Full Name Addres City, State and Zip ( ) ( ) Business Telephone # Business Fax # ATTACHMENT B – PAGE 2 Doing Business As (If Applicable) (Note: This is the name that appears on your invoices, but is not used as your reporting name.) Name and Title of Person Completing this Certificate Physical Business Address Number of Employees Are All Employees Eligible for Employment in the United States? Under penalty of xxxxxxx, I declare on behalf of the contractor/vendor listed above that to the best of my knowledge and based upon reasonable inquiry each and every one of the contractor’s employees is eligible for employment in the United States as required by the Federal Immigration Reform and Control Act of 1986 and Section 40.1-11.1 of the Code of Virginia. I further declare on behalf of the contractor/vendor that due care and diligence shall be used to ensure that all employees hired in the future will be eligible for employment in the United States and that I agree to remain in compliance throughout the duration of the contract. I affirm the information provided herein is true, correct, and complete. I also agree to permit the Chesapeake Public Schools to inspect records and documentation to ensure that all persons hired by the contractor/vendor are eligible for employment under the laws referenced in this certificate when deemed necessary by Chesapeake Public Schools. I agree that the contractor/vendor will fully cooperate in any such audit. Printed Name of Signatory: Signature: Date: For Office Use Only Acknowledged by: Date: If Applicable: Project Name: PO Number: ATTACHMENT C CLAIM OF BUSINESS CONFIDENTIALITY Virginia Procurement Act – Virginia Code § 2.2-4342 Public inspection of certain records: – A. Except as provided in this section, all proceedings, records, contracts and other public records relating to procurement transactions shall be open to the inspection of any citizen, or any interested person, firm or corporation, in accordance with the Virginia Freedom of Information Act (§2.2-3700 et seq.). Trade secrets or proprietary inf...
Type of Business Entity. A. Sole proprietorship (Provide full name and address of owner):
Type of Business Entity. (Check One): [ X ] Corporation; [ ] Limited Liability Corporation [ ] General Partnership; [ ] Limited Partnership; [ ] Not-for-Profit Corporation; [ ] Joint Venture*; [ ] Sole Proprietor; [ ] Other *Each Joint Venture must submit a completed Disclosure of Ownership Interests.
Type of Business Entity. Massachusetts Corporation
