St 220 Ca Form PDF Details

In the labyrinth of tax and finance regulations that businesses navigate, contractors in New York State have a specific procedural form to address: the ST-220-CA. This form, a Contractor Certification to Covered Agency, is a testament to the intricate relationship between a contractor's responsibilities and state tax laws. Instituted by the New York State Department of Taxation and Finance, compliance with Section 5-a of the Tax Law, amended on April 26, 2006, necessitates the completion of this form under certain conditions. Designed to ensure contractors are meeting their tax obligations, the ST-220-CA form requires detailed information about the contractor, including their principal place of business, contract value, and tax identification numbers. It acts as a declaration, to be signed under penalty of perjury, that the contractor has filed or has not needed to file a new Form ST-220-TD due to changes in contract status. The instructions provided along with the form, reference Publication 223 for further clarifications, emphasizing the form's role in contract renewals and the conditions under which it becomes relevant. The form not only facilitates tax compliance but also ensures transparency in the contractor's operations, making it a critical document in the procurement process within New York State's regulatory framework.

QuestionAnswer
Form NameSt 220 Ca Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesnys dept of finance st 220 ca form, 220 ca form, st 220ca, st 220 ca form

Form Preview Example

 

New York State Department of Taxation and Finance

 

 

 

 

ST-220-CA

 

Contractor Certification to Covered Agency

 

(Pursuant to Section 5-a of the Tax Law, as amended, effective April 26, 2006)

(12/11)

 

 

For information, consult Publication 223, Questions and Answers Concerning Tax Law Section 5-a (see Need Help? on back).

 

 

 

 

 

 

 

 

 

Contractor name

 

 

 

 

 

 

 

For covered agency use only

 

 

 

 

 

 

 

 

 

Contract number or description

 

 

 

 

 

 

 

 

 

 

Contractor’s principal place of business

 

 

City

State

ZIP code

 

 

 

 

 

 

 

 

 

 

Contractor’s mailing address (if different than above)

 

 

 

 

 

 

Estimated contract value over

 

 

 

 

 

 

 

 

 

the full term of contract (but not

 

 

 

 

 

 

 

 

 

including renewals)

Contractor’s federal employer identification number (EIN)

Contractor’s sales tax ID number (if different from contractor’s EIN)

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

Contractor’s telephone number

Covered agency name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Covered agency address

 

 

 

 

 

 

 

Covered agency telephone number

 

 

 

 

 

I,

 

, hereby affirm, under penalty of perjury, that I am

 

 

(name)

 

 

 

 

 

 

 

(title)

of the above-named contractor, that I am authorized to make this certification on behalf of such contractor, and I further certify that:

(Mark an X in only one box)

GThe contractor has filed Form ST-220-TD with the Department of Taxation and Finance in connection with this contract and, to the best of contractor’s knowledge, the information provided on the Form ST-220-TD, is correct and complete.

GThe contractor has previously filed Form ST-220-TD with the Tax Department in connection with

(insert contract number or description)

and, to the best of the contractor’s knowledge, the information provided on that previously filed Form ST-220-TD, is correct and complete as of the current date, and thus the contractor is not required to file a new Form ST-220-TD at this time.

Sworn to this

 

day of

 

, 20

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(sign before a notary public)

 

 

 

 

(title)

 

 

 

 

 

 

 

 

 

Instructions

General information

Tax Law section 5-a was amended, effective April 26, 2006. On or after that date, in all cases where a contract is subject to Tax Law section 5-a, a contractor must file (1) Form ST-220-CA, Contractor Certification to Covered Agency, with a covered agency, and

(2)Form ST-220-TD with the Tax Department before a contract may take effect. The circumstances when a contract is subject to section 5-a are listed in Publication 223, Q&A 3. See Need help? for more information on how to obtain this publication. In addition, a contractor must file a new Form ST-220-CA with a covered agency before an existing contract with such agency may be renewed.

Note: Form ST-220-CA must be signed by a person authorized to make the certification on behalf of the contractor, and the acknowledgement on page 2 of this form must be completed before a notary public.

When to complete this form

As set forth in Publication 223, a contract is subject to section 5-a, and you must make the required certification(s), if:

i.The procuring entity is a covered agency within the meaning of the statute (see Publication 223, Q&A 5);

ii.The contractor is a contractor within the meaning of the statute (see Publication 223, Q&A 6); and

iii. The contract is a contract within the meaning of the statute. This is the case when it (a) has a value in excess of $100,000 and (b) is a contract for commodities or services, as such terms are defined for purposes of the statute (see Publication 223, Q&A 8 and 9).

Furthermore, the procuring entity must have begun the solicitation to purchase on or after January 1, 2005, and the resulting contract must have been awarded, amended, extended, renewed, or assigned on or after April 26, 2006 (the effective date of the section 5-a amendments).

Page 2 of 2 ST-220-CA (12/11)

Individual, Corporation, Partnership, or LLC Acknowledgment

STATE OF

 

 

}

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

:

 

SS.:

 

COUNTY OF

}

 

 

 

 

 

 

 

 

 

On the

 

 

 

 

day of

 

 

in the year 20

 

, before me personally appeared

 

 

 

,

 

 

 

 

 

 

 

 

 

 

known to me to be the person who executed the foregoing instrument, who, being duly sworn by me did depose and say that

 

 

 

he resides at

 

 

,

 

Town of

 

 

 

 

 

 

 

,

 

 

 

 

 

 

 

 

 

 

 

County of

 

 

 

 

,

 

 

State of

 

 

 

 

; and further that:

 

 

 

 

 

 

[Mark an X in the appropriate box and complete the accompanying statement.]

G G

G

(If an individual): _he executed the foregoing instrument in his/her name and on his/her own behalf.

(If a corporation): _he is the

 

of

, the corporation described in said instrument; that, by authority of the Board

of Directors of said corporation, _he is authorized to execute the foregoing instrument on behalf of the corporation for purposes set forth therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and on behalf of said corporation as the act and deed of said corporation.

(If a partnership): _he is a

of, the partnership described in said instrument; that, by the terms of said

partnership, _he is authorized to execute the foregoing instrument on behalf of the partnership for purposes set forth therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and on behalf of said partnership as the act and deed of said partnership.

G (If a limited liability company): _he is a duly authorized member of,

LLC, the limited liability company described in said instrument; that _he is authorized to execute the foregoing instrument on behalf of the limited liability company for purposes set forth therein; and that, pursuant to that authority, _he executed the foregoing instrument in the name of and on behalf of said limited liability company as the act and deed of said limited liability company.

Notary Public

Registration No.

Privacy notification

The Commissioner of Taxation and Finance may collect and maintain personal information pursuant to the New York State Tax Law, including but not limited to, sections 5-a, 171, 171-a, 287, 308, 429, 475, 505, 697, 1096, 1142, and 1415 of that Law; and may require disclosure of social security numbers pursuant to 42 USC 405(c)(2)(C)(i).

This information will be used to determine and administer tax liabilities and, when authorized by law, for certain tax offset and exchange of tax information programs as well as for any other lawful purpose.

Information concerning quarterly wages paid to employees is provided to certain state agencies for purposes of fraud prevention, support enforcement, evaluation of the effectiveness of certain employment and training programs and other purposes authorized by law.

Failure to provide the required information may subject you to civil or criminal penalties, or both, under the Tax Law.

This information is maintained by the Manager of Document Management, NYS Tax Department, W A Harriman Campus, Albany NY 12227; telephone (518) 457-5181.

Need help?

Visit our Web site at www.tax.ny.gov

•get information and manage your taxes online

•check for new online services and features

Telephone assistance

 

Sales Tax Information Center:

(518) 485-2889

To order forms and publications:

(518) 457-5431

Text Telephone (TTY) Hotline (for persons with

hearing and speech disabilities using a TTY): (518) 485-5082

Persons with disabilities: In compliance with the

Americans with Disabilities Act, we will ensure that our lobbies, ofices, meeting rooms, and other facilities are

accessible to persons with disabilities. If you have questions about special accommodations for persons with disabilities, call the information center.

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