2-TAX RESIDENCE CERTIFICATION.pdf

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Attached to
RFP - Automated Pharmacy Dispensing System for Centralized Distribution
Solicitation number
26/0061
Issued by
Harris County, Texas

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This is a Tax Form/Debt/Residence Certification document required by Harris County, Texas for bidders on advertised projects. The form serves as a compliance certification for contractors submitting bids or proposals to Harris County, requiring disclosure of taxpayer identification numbers, company registration status in Texas, and any assumed business names under which the bidder operates.

The certification requires bidders to list all taxable property owned in Harris County, including property account numbers and addresses, and to disclose any outstanding debts owed to Harris County such as taxes, fines, tolls, or court judgments. Additionally, bidders must certify their residency status in Texas in accordance with Texas Government Code 2252.001 et seq., declaring whether they qualify as a resident bidder with a principal place of business in Texas or as a nonresident bidder with their principal place of business located outside the state. This residency classification impacts contract award eligibility under Texas law governing preferential treatment for in-state contractors on governmental contracts.

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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 .