2-Tax Residence Certification.pdf
PDF 24 KB Posted
- Attached to
- RFP - Class D Pharmacy Inventory Management Program (CDP-IMP) for Harris County Public Health Services
- Solicitation number
- 26/0070
- Issued by
- Harris County, Texas
About this file
This is a Tax Form/Debt/Residence Certification document required by Harris County, Texas for bidders submitting proposals on advertised projects. The form applies to the Class D Pharmacy Inventory Management Program (CDP-IMP) for Harris County Public Health Services, with a contract term of one year beginning approximately July 1, 2026. Bidders must complete this certification as part of their proposal submission to establish their business registration status, property ownership, and debt obligations within Harris County.
The certification requires bidders to provide their Taxpayer Identification Number, company name, mailing address, and confirmation of business registration in Texas. Bidders must list all taxable property owned in Harris County, including property account numbers and addresses, and disclose any debts owed to Harris County such as taxes, fines, tolls, or court judgments. Additionally, bidders must certify their residency status under Texas Government Code 2252.001, designating themselves as either a resident bidder (with principal place of business in Texas) or a nonresident bidder (with principal place of business outside Texas). This certification ensures compliance with Texas statutory restrictions on governmental contract awards based on residency requirements.
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Text version
TAX FORM/DEBT/ RESIDENCE CERTIFICATION
(for Advertised Projects)
Taxpayer Identification Number (T.I.N.):
Company Name submitting Bid/Proposal:
Mailing Address:
Are you registered to do business in the State of Texas? Yes No
If you are an individual, list the names and addresses of any partnership of which you are a general partner or any assumed name(s) under which you operate your business
I. Property: List all taxable property in Harris County owned by you or above partnerships as well as any d/b/a names. (Use a second sheet of paper if necessary.)
Harris County Tax Acct. No.* Property address or location**
* This is the property account identification number assigned by the Harris County Appraisal District.
** For real property, specify the property address or legal description. For business personal property, specify the address where the property is located. For example, office equipment will normally be at your office, but inventory may be stored at a warehouse or other location.
II. Harris County Debt - Do you owe any debts to Harris County (taxes on properties listed in I above, tickets, fines, tolls, court judgments, etc.)?
Yes No If yes, attach a separate page explaining the debt.
III. Residence Certification - Pursuant to Texas Government Code §2252.001 et seq., as amended, Harris County requests Residence Certification. §2252.001 et seq. of the Government Code provides some restrictions on the awarding of governmental contracts; pertinent provisions of §2252.001 are stated below:
(3) "Nonresident bidder" refers to a person who is not a resident.
(4) "Resident bidder" refers to a person whose principal place of business is in this state, including a contractor whose ultimate parent company or majority owner has its principal place of business in this state.
I certify that is a Resident Bidder of Texas as defined in Government Code
[Company Name]
§2252.001.
I certify that is a Nonresident Bidder as defined in Government Code
[Company Name]
§2252.001 and our principal place of business is .
[City and State] Revised 11/09
| for Advertised Projects: |
| undefined: |
| Company Name submitting BidProposal: |
| Are you registered to do business in the State of Texas: Off |
| assumed names under which you operate your business 1: |
| assumed names under which you operate your business 2: |
| Harris County Tax Acct No 1: |
| Harris County Tax Acct No 2: |
| Harris County Tax Acct No 3: |
| Harris County Tax Acct No 4: |
| Property address or location 1: |
| Property address or location 2: |
| Property address or location 3: |
| Property address or location 4: |
| fines tolls court judgments etc: Off |
| I certify that: |
| is a Resident Bidder of Texas as defined in Government Code: |
| I certify that_2: |
| Company Name: |
| is a Nonresident Bidder as defined in Government Code: |
File details come from the government source that posted it. Updated .