Wh-5 Public Works Contract Report Page 2
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1
2all subcontractors (continueD)
Name
Federal EIN
Address
Public works contractor number
City, State, ZIP
Amount of subcontract
LLC
Corporation
Sole proprietorship
Partnership
$
Description of work
Name
Federal EIN
Address
Public works contractor number
City, State, ZIP
Amount of subcontract
LLC
Corporation
Sole proprietorship
Partnership
$
Description of work
Name
Federal EIN
Address
Public works contractor number
City, State, ZIP
Amount of subcontract
LLC
Corporation
Sole proprietorship
Partnership
$
Description of work
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.
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
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
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
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
* 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
Authorized signature
Print name
Phone number
Date
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.
EFO00168p2 04-28-11
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