3-WH-5 Public Works Contract Report.pdf
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- Solicitation number
- PW-F-26-34901-2029
- Issued by
- Ada County, Idaho
About this file
This document is a WH-5 Public Works Contract Report from the Idaho State Tax Commission for the West Ada School District, located at 1303 E Central Drive, Meridian, ID 83642. The form is a mandatory tax reporting document required by Idaho Code sections 54-1904A and 63-3624(g) for all public works contracts, which must be filed with the Tax Commission within 30 days after a contract is awarded. The form provides a template for reporting project details, including project dates, contractor information, subcontractors, and supplier information.
The document is designed to capture comprehensive details about public works contracts, including business entity type, federal employer identification numbers, state incorporation details, and tax permit information. It requires reporting of all subcontractors, their work descriptions, contract amounts, and business structures, as well as details about major suppliers of materials and equipment. The form also includes sections for documenting how sales and use taxes were paid, with options to indicate tax payment to suppliers, to the state, or if no tax was paid. The form must be signed and filed with the Idaho State Tax Commission, with contact information provided for further inquiries.
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Idaho State Tax Commission
WH-5 Public Works Contract Report Idaho Code sections 54-1904A and 63-3624(g) require all public works contracts to be reported to the Tax Commission. This form must be filed with the Tax Commission within 30 days after a contract is awarded.
Project Dates Scheduled project start date: _______________________ Completion date: ____________________________
If the following information is not available at this time, please indicate date it will be: ____________________________
All Subcontractors
EFO00168 04-28-11
Contract awarded by (public body and address)
Contract awarded to (contractor’s name and address)
State of incorporation Federal Employer Identification Number (EIN) Date qualifed to do business in Idaho
Business operates as Public Works contractor license number
Sole proprietor’s Social Security number Idaho sales/use tax permit number Idaho withholding tax permit number
Awarding agency project number Amount of contract
Description and location of work to be performed
Name Federal EIN
Address Public works contractor number
City, State, ZIP Amount of subcontract
Description of work
Name Federal EIN
Address Public works contractor number
City, State, ZIP Amount of subcontract
Description of work
Name Federal EIN
Address Public works contractor number
City, State, ZIP Amount of subcontract
Description of work
Name Federal EIN
Address Public works contractor number
City, State, ZIP Amount of subcontract
Description of work
Sole proprietorship Partnership Corporation LLC
| LLC | Corporation |
| Sole proprietorship | Partnership |
| LLC | Corporation |
| Sole proprietorship | Partnership |
| LLC | Corporation |
| Sole proprietorship | Partnership |
| LLC | Corporation |
| Sole proprietorship | Partnership |
Ref. No. (State use only)
EFO00168p2 04-28-11
All Subcontractors (Continued)
Suppliers Use the space below to report major suppliers of materials and supplies; items removed from inventory; equipment purchased, rented, or leased for use in project; materials provided by government agency. Please indicate how sales or use tax was paid.
* If tax was not paid to suppliers but was or will be reported as “items subject to use tax” under your permit number, indicate period of return on which payment was or will be reported: _______________________________________ If tax was paid to a state other than Idaho, name state next to “total value” box(es) above. If tax is due and has not previously been reported, attach payment to this form. If you need more room, please photocopy this page.
SIGN
HERE
File with the Idaho State Tax Commission, PO Box 36, Boise ID 83722-2210.
For more information, call (208) 334-7618 • Fax: (208) 332-6619 • E-mail: Contractdesk@tax.idaho.gov.
Authorized signature Print name Phone number Date
Name Federal EIN
Address Public works contractor number
City, State, ZIP Amount of subcontract
Description of work
Name Federal EIN
Address Public works contractor number
City, State, ZIP Amount of subcontract
Description of work
Name Federal EIN
Address Public works contractor number
City, State, ZIP Amount of subcontract
Description of work
Name Federal EIN Total value
Address Materials and equipment purchased and used
City, State, ZIP Phone
Name Federal EIN Total value
Address Materials and equipment purchased and used
City, State, ZIP Phone
Name Federal EIN Total value
Address Materials and equipment purchased and used
City, State, ZIP Phone
Name Federal EIN Total value
Address Materials and equipment purchased and used
City, State, ZIP Phone
Tax paid to supplier Tax paid to state* No tax paid
Tax paid to supplier Tax paid to state* No tax paid
Tax paid to supplier Tax paid to state* No tax paid
Tax paid to supplier Tax paid to state* No tax paid
| LLC | Corporation |
| Sole proprietorship | Partnership |
| LLC | Corporation |
| Sole proprietorship | Partnership |
| LLC | Corporation |
| Sole proprietorship | Partnership |
| Contract awarded by: WEST ADA SCHOOL DISTRICT, 1303 E CENTRAL DRIVE, MERIDIAN, ID 83642 |
| Contract awarded to: |
| State of incorporation: |
| EIN: |
| Date qualified to do business in Idaho: |
| Sole proprietorship: Off |
| Partnership: Off |
| Corporation: Off |
| LLC: Off |
| Public Works contractor license number: |
| Sole proprietor's Social Security number: |
| 0: |
| 0: |
| Idaho sales/use tax permit number: |
| Idaho withholding tax permit number: |
| Awarding agency project number: |
| Amount of contract: |
| Description and location of work to be performed: |
| Scheduled project start date: |
| 0: |
| Completion date: |
| Date it will be available: |
| Subcontractor #1 name: |
| Subcontractor #1 address: |
| Subcontractor #1 City, State, Zip: |
| Subcontractor #1 EIN: |
| Subcontractor #1 Public works contractor number: |
| Subcontractor #1 LLC: Off |
| Subcontractor #1 Sole proprietorship: Off |
| Subcontractor #1 Corporation: Off |
| Subcontractor #1 Partnership: Off |
| Subcontractor #1 Amount of subcontract: |
| Subcontractor #1 Description of work: |
| Subcontractor #2 name: |
| Subcontractor #2 address: |
| Subcontractor #2 City, State, Zip: |
| Subcontractor #2 EIN: |
| Subcontractor #2 Public works contractor number: |
| Subcontractor #2 LLC: Off |
| Subcontractor #2 Sole proprietorship: Off |
| Subcontractor #2 Corporation: Off |
| Subcontractor #2 Partnership: Off |
| Subcontractor #2 Amount of subcontract: |
| Subcontractor #2 Description of work: |
| Subcontractor #3 name: |
| Subcontractor #3 address: |
| Subcontractor #3 City, State, Zip: |
| Subcontractor #3 EIN: |
| Subcontractor #3 Public works contractor number: |
| Subcontractor #3 LLC: Off |
| Subcontractor #3 Sole proprietorship: Off |
| Subcontractor #3 Corporation: Off |
| Subcontractor #3 Partnership: Off |
| Subcontractor #3 Amount of subcontract: |
| Subcontractor #3 Description of work: |
| Subcontractor #4 name: |
| Subcontractor #4 address: |
| Subcontractor #4 City, State, Zip: |
| Subcontractor #4 EIN: |
| Subcontractor #4 Public works contractor number: |
| Subcontractor #4 LLC: Off |
| Subcontractor #4 Sole proprietorship: Off |
| Subcontractor #4 Corporation: Off |
| Subcontractor #4 Partnership: Off |
| Subcontractor #4 Amount of subcontract: |
| Subcontractor #4 Description of work: |
| Subcontractor #5 name: |
| Subcontractor #5 address: |
| Subcontractor #5 City, State, Zip: |
| Subcontractor #5 EIN: |
| Subcontractor #5 Public works contractor number: |
| Subcontractor #5 LLC: Off |
| Subcontractor #5 Sole proprietorship: Off |
| Subcontractor #5 Corporation: Off |
| Subcontractor#5 Partnership: Off |
| Subcontractor #5 Amount of subcontract: |
| Subcontractor #5 Description of work: |
| Subcontractor #6 name: |
| Subcontractor #6 address: |
| Subcontractor #6 City, State, Zip: |
| Subcontractor #6 EIN: |
| Subcontractor #6 Public works contractor number: |
| Subcontractor #6 LLC: Off |
| Subcontractor #6 Sole proprietorship: Off |
| Subcontractor #6 Corporation: Off |
| Subcontractor #6 Partnership: Off |
| Subcontractor #6 Amount of subcontract: |
| Subcontractor #6 Description of work: |
| Subcontractor #7 name: |
| Subcontractor #7 address: |
| Subcontractor #7 City, State, Zip: |
| Subcontractor #7 EIN: |
| Subcontractor #7 Public works contractor number: |
| Subcontractor #7 LLC: Off |
| Subcontractor #7 Sole proprietorship: Off |
| Subcontractor #7 Corporation: Off |
| Subcontractor #7 Partnership: Off |
| Subcontractor #7 Amount of subcontract: |
| Subcontractor #7 Description of work: |
| Supplier #1 name: |
| Supplier #1 address: |
| Supplier #1 City, State, Zip: |
| Supplier #1 Phone: |
| Supplier #1 EIN: |
| Supplier #1 Total value: |
| Supplier #1 materials/equipment purchased and used: |
| Supplier #1 Tax paid to supplier: |
| 0: Off |
| Supplier #1 Tax paid to state: Off |
| Supplier #1 No tax paid: Off |
| Supplier #2 name: |
| Supplier #2 address: |
| Supplier ##2 City, State, Zip: |
| Supplier #2 Phone: |
| Supplier #2 EIN: |
| Supplier #2 Total value: |
| Supplier #2 materials/equipment purchased and used: |
| Supplier #2 Tax paid to supplier: |
| 0: Off |
| Supplier #2 Tax paid to state: Off |
| Supplier #2 No tax paid: Off |
| Supplier #3 name: |
| Supplier #3 address: |
| Supplier #3 City, State, Zip: |
| Supplier #3 Phone: |
| Supplier #3 EIN: |
| Supplier #3 Total value: |
| Supplier #3 materials/equipment purchased and used: |
| Supplier #3 Tax paid to supplier: |
| 0: Off |
| Supplier #3 Tax paid to state: Off |
| Supplier #3 No tax paid: Off |
| Supplier #4 name: |
| Supplier #4 address: |
| Supplier #4 City, State, Zip: |
| Supplier #4 Phone: |
| Supplier #4 EIN: |
| Supplier #4 Total value: |
| Supplier #4 materials/equipment purchased and used: |
| Supplier #4 Tax paid to supplier: |
| 0: Off |
| Supplier #4 Tax paid to state: Off |
| Supplier #4 No tax paid: Off |
| tax not paid date was/will be reported: |
| Print name: |
| Phone number: |
| Date signed: |
File details come from the government source that posted it. Updated .