3-Tax Residence Certification.pdf

PDF 24 KB Posted

Attached to
CSP - MRI Scan Equipment Replacement and MRI Suite Renovation at Smith Clinic for Harris Health (Estimated Budget $1, 924, 067)
Solicitation number
26/0002
Issued by
Harris County, Texas

About this file

Written by GovTribe AI ·

This is a Tax Residence Certification form required by Harris County, Texas for bidders on advertised projects, specifically for the MRI Scan Equipment Replacement and MRI Suite Renovation at Smith Clinic for Harris Health, with an estimated budget of $1,924,067. The form serves as a compliance document to establish the bidder's residency status and tax obligations within Harris County and the State of Texas. Bidders must provide their Taxpayer Identification Number, company name, mailing address, and business registration status in Texas. The form requires bidders to list all taxable property owned in Harris County, including property account numbers and specific addresses or legal descriptions for real property, business personal property, and inventory locations.

The certification addresses three critical compliance areas: property ownership in Harris County, outstanding debts owed to Harris County (including taxes, tickets, fines, tolls, and court judgments), and residency status as defined by Texas Government Code 2252.001. Bidders must certify whether they qualify as a resident bidder, defined as a person whose principal place of business is in Texas (including contractors whose ultimate parent company or majority owner is based in Texas), or as a nonresident bidder and provide the city and state of their principal place of business. This form is mandatory for bid submission and establishes the legal foundation for contract award eligibility under Texas state law governing governmental contract restrictions based on residency status.

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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 .