ESBD_File_348774_ATTACHMENT G.2 Application for Texas ID #_AP_152.pdf

PDF 685 KB Posted Jan 31, 2024

Attached to: HVAC REPLACEMENT
Solicitation number: TMD24-FMO-0033739
Issued by: Palo Pinto County, Mission City, Texas

About this file

Written by GovTribe AI · Apr 2, 2024

This document is an Application for a Texas Identification Number (TIN) for a state and local contract opportunity. The Texas Military Department (TMD) is seeking a contractor to remove and dispose of two chiller, boiler, and humidifier systems, and install two new HVAC 12.5 Ton, Three-Phase Power (3ph) 230 volt (v) electric systems with 20 Kilowatts (KW) Heat at a location in Mineral Wells, Texas, which is located in Stephens County. The contract requires all labor, materials, and equipment for this HVAC replacement project.

The application form collects information such as the payee's name, mailing address, telephone number, ownership type, and tax identification number, which will be used to assign a TIN for billing and payment purposes. The form also includes sections for payment assignment and any additional comments. This information is required for the contractor to receive payments from the state agency for the goods and services provided under the HVAC replacement contract.

View the file

Other files

File	Type	Posted
ESBD_File_348774_ATTACHMENT G.3 Pricing Schedule.pdf	PDF	Jan 31, 2024
ESBD_File_348774_Addendum 2 - TMD24-FMO-0033739.pdf	PDF	Jan 31, 2024
ESBD_File_348774_ATTACHMENT G.1 Direct Deposit 74-176.pdf	PDF	Jan 31, 2024
ESBD_File_348774_ATTACHMENT G.4 TMD Standard Terms and Conditions.pdf	PDF	Jan 31, 2024
ESBD_File_348774_TMD24-FMO-0033739 HVAC REPLACEMENT.pdf	PDF	Jan 31, 2024
ESBD_File_348774_Addendum 1 - TMD24-FMO-0033739.pdf	PDF	Jan 31, 2024

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SIC

code

Payee	Information	(Please type or print)
	4.	Name	of	payee	(Individual	or	business	to	be	paid)

5. Mailing address where you want to receive payments

6. (Optional)

7. (Optional)

8. (Optional)

9. City State ZIP code

10.

Payee telephone number (Area code and number)

Security type code ( 0, 1, 2 )

Zone code

2.	Texas	Identification	Number	(TIN)	-	Indicate the type of number you are providing to be used for your TIN
Employer	Identification	Number	(EIN)	(9 digits)

(SSN)Social Security number (9 digits)

Individual Taxpayer Identification Number (ITIN) (9 digits)

Comptroller's	assigned	number	(FOR	STATE	AGENCY	USE	ONLY)	(11 digits)
Current	Texas	Identification	Number	(FOR	STATE	AGENCY	USE	ONLY)	(11 digits)

3.	Are	you	currently	reporting	any	Texas	tax	to	the	Comptroller's
office	such	as	sales	tax	or	franchise	tax?	YES	NO

Enter the number indicated

If "YES," enter Texas Taxpayer Number

1. Is this a new account? YES Mail Code 000 NO Enter Mail Code Agency number Complete Sections 1 - 5 Complete Sections 1, 2 & 5

For Comptroller's use only

11. Ownership Codes - Check only one code by the appropriate ownership type that applies to you or your business.

L - Texas Limited Partnership:

If checked, enter the

Texas File Number

Owner's name

T - Texas Corporation:

If checked, enter the Texas File Number

SSN / ITIN (9 digits) A - Professional Association:

If checked, enter the Texas File Number

If checked, enter the exas File Number

C - Professional Corporation:

Name

SSN / ITIN / EIN (9 digits)

Name

SSN / ITIN / EIN (9 digits)

I - Individual Recipient (not owning a business)

S	-	Sole	Ownership	(Individual	owning	a	business):	If	checked,
enter	the	owner's	name	and	Social	Security	number	(SSN)

P - Partnership: If checked, enter two partner's names and

Social	Security	numbers	(SSN).	If	a	partner	is	a	corporation,	use
the	corporation's	Employer	Identification	Number	(EIN).

O - Out-of-State Corporation

G - Governmental Entity

U - State agency / University

F - Financial Institution

R - Foreign (out of U.S.A.)

N - Other: If checked, explain.

12. Payment Assignment? YES NO Note: A copy of the assignment agreement between payees must be attached.

Assignee name

Assignee TIN Assignment date

13. Comments Authorized signature (Applicant or authorized agent) Date

14.

Agency name Prepared by Phone (Area code and number)

15.

AP-152

(Rev.8-21/18)

Application for Texas Identification Number

• See instructions on back

Se ct io n

Form AP-152 (Back)(Rev.8-21/18)

Application for Texas Identification Number Instructions G L E N N H E G A R T E X A S C O M P T R O L L E R O F P U B L I C A C C O U N T S

Who

Must

Submit

This

Application

This

application

must

submitted

every

person

(sole

owner,

individual

recipient,

partnership,

corporation

other

organization)

who

intends

to bill agencies of the state government for goods, services provided, refunds, public assistance, etc. When the application is processed by the

state

agency

with

which

the

applicant

conducting

business,

Texas

Identification

Number

(TIN)

will

assigned

and

will

required

all

maintenance

and

payment

requests

submitted

state

agencies.

For

Assistance

For

assistance

completing

this

application,

contact

the

state

agency

from

which

the

form

was

received

obtained.

The

applicant

must

return

the completed application to the state agency with which the applicant is conducting business.

Note

State

Agencies: When this form is used to set up additional mail codes after a TIN has been set up, Sections 1, 2 and 5 must be com-

pleted.

See

FMX's

TexPayment

Resource

(TPR)

for

additional

information.

Call

Payment

Services

512-936-8138

tins.mail@cpa.texas.gov

your

agency

has

questions

about

the

TPR

requirements

and/or

needs

assistance

for

their

payees

completing

the

application or with processing the form.

General

Instructions

•

not

use

dashes

when

entering

the

9-digit

Employer

Identification

Number

(EIN),

Social

Security

number

(SSN),

Individual

Taxpayer

Identification

Number

(ITIN).

•

Disclosure

your

Social

Security

number

required.

This

disclosure

requirement

has

been

adopted

under

the

Federal

Privacy

Act

1974

U.S.C.A.

sec.

552a(note)(West

1977),

the

Tax

Reform

Act

1976

(42

U.S.C.A.

sec.

405(c)(2)(C)

(West

1992),

TEX.

GOV'T.

CODE

ANN.

sec.

403.055

(Vernon

2005)

and

TEX.

GOV'T.

CODE

ANN.

sec.

403.056

(Vernon

2005).

Your

Social

Security

number

will

used

help

the

Texas

Comptroller

Public

Accounts

administer

the

state's

tax

laws

and

for

other

purposes.

See

Tex.

Att'y

Gen.

No.

H-1255

(1978).

Specific Instructions Item 1: Is this a new account?

Select YES if the applicant has never received a payment from a Texas state agency and does not have an assigned TIN.

Select NO if the applicant has received payments from a Texas state agency and already has an assigned TIN.

Mail Code / Agency number – Will be entered by the state agency that processes the application.

Section

—

Texas

Identification

Number

EIN:

For

all

ownership

codes

other

than

Individual

Recipient

listed

Section

enter

9-digit

Employer

Identification

Number

(EIN)

is-

sued

the

Internal

Revenue

Service

(IRS).

SSN:

For

individuals

sole

owners

who

choose

not

apply

with

their

EIN,

enter

your

9-digit

Social

Security

number

(SSN)

issued

the

Social

Security

Administration.

ITIN:

For

individuals

who

not

qualify

for

SSN,

enter

your

9-digit

Individual

Taxpayer

Identification

Number

(ITIN)

issued

the

IRS.

Comptroller

Assigned

Number

(FOR

STATE

AGENCY

USE

ONLY):

This

11-digit

Comptroller-assigned

number

provided

state

agency that needs to pay a foreign entity or a foreign individual who does not have an EIN, SSN or ITIN.

Current Texas Identification Number (FOR STATE AGENCY USE ONLY): The 11-digit current Comptroller-assigned TIN.

Section

—

Payee

Information

Items

4-8:

Enter

the

complete

name

and

mailing

address

where

payments

are

received.

Names

individuals

must

entered

first

name

first,

middle

initial

(if

applicable),

last

name,

suffix

(if

applicable).

The

name

must

not

include

period

(.),

comma

(,)

percent

sign

(%).

Each

line

cannot

exceed

characters

including

spaces.

the

name

than

characters,

continue

the

name

Item

and begin the address in Item 6.

Item 9: Enter the city, state and ZIP code.

Item 10: Enter the payee telephone number.

SIC code / Security type code / Zone code – These fields will be completed by the state agency that will process the application.

Section

—

Ownership

Codes

Item

11:

Check

the

box

the

appropriate

ownership

code

and

enter

additional

information

requested

the

selected

code.

Check

only

one

box

this

section.

The

Texas

Secretary

State's

office

may

contacted

512-463-5555

for

information

regarding

Texas

File

Number

required

for

codes

and

Section 4 — Payment Assignment Item 12: Select YES if the payee is assigning its payments to a third party and the state agency that will process the application has ap-

proved	the	assignment	request.	Also,	complete	the	following:
• Assignee	name: Provide the assignee’s name as listed on the assignment agreement. A copy of the agreement must be

attached.

• Assignee	TIN: Provide the assignee’s EIN if it is a business entity or an SSN or ITIN for an individual.
• Assignment	date: Provide the date the assignment agreement was signed.

Select NO if the payee is not assigning its payments to a third party.

Section

—

Comments

and

Identification

Item

13:

Enter

any

additional

information

that

may

helpful

processing

this

application.

Items

and

are

for

identification

purposes.

Always

complete

the

identification

section,

including

comments

and

authorized

signature.

Item

14:

Authorized

signature

and

Date.

Sign

the

application,

required

the

state

agency

that

will

process

the

form.

Enter

the

date signed.

Item 15: Agency name, Prepared by, Phone: Will be entered by the state agency that will process the application.

Under Ch. 559, Government Code, you are entitled to review, request and correct information we have on file about you, with limited exceptions in accordance with Ch. 552, Government Code. To request information for review or to request error correction, contact us at the address or phone numbers listed on this form.

https://fmx.cpa.texas.gov/fm/pubs/payment/ mailto: tins.mail@cpa.texas.gov

Item1: Off

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Item3a:

Item9C:

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Item11b:

Item11c:

Item11e:

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Item11k:

Item11l:

Item11m:

Item11i:

Item12: Off

Item12b:

Item12c:

Item12d:

Item13:

Item14:

Clear:

SIC1:

IntUse2: AGENCY USE ONLY

STC:

ZC1:

IntUse1: AGENCY USE ONLY

Item15A:

Item15B:

Item15C:

Item4:

Item5:

Item6:

Item7:

Item8:

Item9a:

Item9b:

Print:

IntUse3: AGENCY USE ONLY

Item2a:

Item2a9: 843785020

Item2K:

File details come from the government source that posted it. Updated Apr 2, 2024.