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<br /> @ (::::::"' AP-152-3 Page 2. I For CompuolMl(s use only I <br /> '. ,"::' (5-39) <br /> T~AS APPLICATION FOR PAYEE IDENTIFICATION NUMBER <br /> . Shaded areas for state agency use only <br /> 14. Name of pay.. (SatMIIS II"", ") Pa}'88 number (satM.. h.", 2) <br /> City of San Marcos 171416101 01212131R'I I ! <br /> <br /> 15. BUSINESS INFORMAllON FOR STAllSllCAL REPOR1lNG - A business enterprise is a corporation, partnership. sole proprietorship or <br /> other legal entity formed for the purpose of making a profit. Please check all categories that apply to your business., Providing the <br /> information requested in this section is. voluntary. <br /> 0 Small Business enterprise -an enterprise which is independently owned and operated and has fewer than 100 employees or has <br /> less than $1,000,000 in ànnual gross receipts. <br /> 0 D.lsadvantaged Business enterprise. an enterprise at least 51% of which is owned or controlled by one or more socially <br /> disadvantaged persons. Please check the category which best describes your businesS ownership. <br /> ! 0 Black 0 Hispanic 0 American Indian <br /> 0 Asian American 0 Eskimo 0 Aleut. <br /> ¡ 0 Other - Specify <br /> -I <br /> 0 Woman Owned Business Enterprise - an enterprise at least 51% of which is owned or controlled by women. <br /> Do you have a disadvantaged business enterprise certificate on file with the Texas Department of Commerce'} DYES ONO <br /> 2 CJ Other busineSs enterprise - an enterprise not described in one of the categones shown above. <br /> z <br /> 0 16.. BUSINESS DESCRIP1l0NCODES (For State Agency use only) <br /> ¡::: <br /> <.) I I Business Description Code for this business. If not certified withTDOC. add 1 00 to the appropriate code. <br /> w <br /> en I I <br /> 01 Small 18 Disadvantaged Eskimo <br /> 19 SmallDisadvantagedEskimo <br /> \ 02 DisadvantagedBlack 2(} Woman Owned Dîsadvantaged Eskimo <br /> 03 Small DisadvamagedBlack 21 Small Woman Owned Disadvantaged Eskimo <br /> D4 Woman Owned Disadvantaged Black <br /> 05 Small Woman Owned Disadvantaged Black 22 Disadvantaged Aleut <br /> 23 Small Disadvantaged Aleut <br /> 06 Disadvantaged Hispanic 24 Woman Owned Disadvantaged Aleut <br /> 07 Small Disadvantaged Hispanic 25 Small Woman Owned Disadvantaged Aleut <br /> 08 Woman Owned Disadvantaged Hispanic <br /> 09 Small Woman Owned Disadvantaged Hispanic 26 Disadvantaged - Other <br /> 27 Small Disadvantaged, - Other <br /> 10 Disadvantaged American Indian 28 Woman Owned Disadvantaged - Other <br /> 11 Small Disadvantaged American Indian 29 SmailWoman Owned Disadvantaged- Other <br /> 12 Woman Owned Disadvantaged American Indian <br /> 13 Small Woman Owned Disadvantaged American Indian 30 Woman Owned <br /> 31 SmallWoman Owned <br /> ,- 14 Disadvantaged AsianAmeñcan <br /> 15 Small Disadvantaged Asian American 32 Disadvantaged - Unspecified <br /> 16 Woman Owned Disadvantaged Asian American <br /> 17 Small Woman Owned Disadvantaged Asian American 33 Other Business Enterprise <br /> <br /> ::> 17.0 PAYMENT ASSIGNMENT INFORMATION NOT£: A copy of the assignment agreement between payees must be. attached. <br /> z I I <br /> Q Assignee name <br /> I- <br /> 0 <br /> W ¡ 1 1 I <br /> (/) Assignee PIN I Assignment date I I I I <br /> I I ¡ I I I I I t <br /> 18. Comments <br /> <br /> <br /> ;;: <br /> z sign. AppbntZedage~{ Ad! I Phcn&. (Arøacøt» and,nulnber:l 1Dæe <br /> 0 <br /> ¡:: 19. here",. / . <br /> t) <br /> w -/ 0 \J <br /> C/) <br /> 20. AGENCY IDENTIFICATION ~nc:y number I I I I <br /> <br /> ~nc:y - 1 Agenc:ynlpntMnta1iYe I Phone(Arøa cod4t andruirrrNr) <br /> <br />