Form WH-5
                         Public Works Contract Report

Contractors awarded Idaho public works contracts must submit this form to the Tax Commission within 30 days of 
receiving the award. (Idaho Code sections 54-1904A and 63-3624(g)). 
Contract awarded by (public body and address)

Contract awarded to (contractor’s name and address)

State of incorporation         Federal Employer Identification Number (EIN)                Date qualified to do business in Idaho

Business operates as                                                                       Public works contractor license number
     Sole Proprietorship       Partnership         Corporation                 LLC
Sole proprietor’s Social Security number           Idaho sellers permit number             Idaho withholding tax permit number

Awarding agency project number                                                             Amount of contract
                                                                                           $
Description and location of work to be performed

                                                   Project Dates

Scheduled project start date:                                                     Completion date: 

If the following information isn’t available at this time, please enter date it will be:
                                                   All Subcontractors
Name                                                                                       Federal EIN

Address                                                                                    Public works contractor license number

City                                                           State              ZIP Code         Amount of subcontract
                                                                                                   $
Description of work

Name                                                                                       Federal EIN

Address                                                                                    Public works contractor license number

City                                                           State              ZIP Code         Amount of subcontract
                                                                                                   $
Description of work

Name                                                                                       Federal EIN

Address                                                                                    Public works contractor number

City                                                           State              ZIP Code         Amount of subcontract
                                                                                                   $
Description of work

Name                                                                                       Federal EIN

Address                                                                                    Public works contractor license number

City                                                           State              ZIP Code         Amount of subcontract
                                                                                                   $
Description of work

EFO00168    05-27-2020                                                                                                   Page 1 of 2

                                                                                                         Form WH-5     (continued)
                                         All Subcontractors (continued)
Name                                                                                   Federal EIN

Address                                                                                Public works contractor license number

City                                                         State       ZIP Code            Amount of subcontract
                                                                                             $
Description of work

Name                                                                                   Federal EIN

Address                                                                                Public works contractor license number

City                                                         State       ZIP Code            Amount of subcontract
                                                                                             $
Description of work

Name                                                                                   Federal EIN

Address                                                                                Public works contractor license number

City                                                         State       ZIP Code            Amount of subcontract
                                                                                             $
Description of work

                                                             Suppliers
List your major suppliers of materials, equipment, and supplies. Include items removed from inventory and items provided to you 
by the government agency for use in this project. 
Name                                                         Federal EIN                     Total value
                                                                                             $
Address                                                      Materials and equipment purchased and used

City, State, ZIP Code                    Phone number        Please select how sales or use tax was paid.
                                                                  Tax paid to supplier Tax paid to state*         No tax was paid
Name                                                         Federal EIN                     Total value
                                                                                             $
Address                                                      Materials and equipment purchased and used

City, State, ZIP Code                    Phone number        Please select how sales or use tax was paid.
                                                                  Tax paid to supplier Tax paid to state*         No tax was paid
Name                                                         Federal EIN                     Total value
                                                                                             $
Address                                                      Materials and equipment purchased and used

City, State, ZIP Code                    Phone number        Please select how sales or use tax was paid.
                                                                  Tax paid to supplier Tax paid to state*         No tax was paid
*If you’re reporting any untaxed materials, equipment, or supplies as “items subject to use tax” on your Idaho return, 
provide the period when you did or will report it:
If you paid tax to a state other than Idaho, write the name state next to “total value” boxes, above. For any tax due that you 
haven’t reported yet, include payment with this form. You can make copies of this form is you need more room.
Sign    Authorized signature                      Print name                    Phone number              Date
Here
                      File with the Idaho State Tax Commission, PO Box 36, Boise ID 83722-0410
        For more information, call (208) 334-7618    | Fax: (208) 332-6619    | Email: contractdesk@tax.idaho.gov 
EFO00168    05-27-2020                                                                                                  Page 2 of 2