Certificate of Interested Parties. FORM 1295 1 of 1 Complete Nos. 1 - 4 and 6 if there are interested parties. Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Cummins Southern Plains LLC Certificate Number: 2023-977746 Houston, TX United States Date Filed: 01/30/2023 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 02/07/2023 3 Provide the identification number used by the governmental entity or state agency to track or identify the contract, and provide a description of the services, goods, or other property to be provided under the contract. 23-Fac-100187 Generator Maintenance & Services 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 6 UNSWORN DECLARATION My name is , and my date of birth is . My address is , , , , . (street) (city) (state) (zip code) (country) I declare under penalty of perjury that the foregoing is true and correct. Executed in County, State of , on the day of , 20 . (month) (year) Signature of authorized agent of contracting business entity (Declarant) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx
Certificate of Interested Parties. (Form 1295) In connection with an amendment to this Agreement, including any Change Order or Deviation, DB Contractor shall either (i) provide a certification to TxDOT certifying that there has been no change to the Interested Parties (as that term is defined in § 2252.908 of the Texas Government Code and in 1 T.A.C. § 46.3) disclosed in the most recent Form 1295, Certificate of Interested Parties (“Form 1295”) filed by DB Contractor with the Texas Ethics Commission in connection with this Capital Maintenance Contract, as required by Section 2252.908 of the Texas Government Code and Chapter 46 of Title 1 of the Texas Administrative Code (collectively, the “Form 1295 Laws”), or (ii) if there has been a change to the disclosure of Interested Parties or if the value of the amendment is $1,000,000 or greater, file a new Form 1295 with the Texas Ethics Commission as required by the Form 1295 Laws. DB Contractor shall indicate the CSJ for this Capital Maintenance Contract and the applicable Change Order, Deviation or amendment number in the fields provided on Form 1295. If DB Contractor is required to file a Form 1295 pursuant to this Section 4.5.7.5 in connection with any amendment, including a Change Order or Deviation, DB Contractor must submit to TxDOT an executed and notarized Form 1295 complying with the requirements of the Form 1295 Laws at the same time it submits the executed amendment, including any Change Order or Deviation, for TxDOT’s execution. TxDOT will not execute any Change Order or other amendment to this Capital Maintenance Contract until it has received either the certification or the Form 1295 as required by this Section 4.5.7.5; provided, that DB Contractor’s filing of such certification or Form 1295 does not obligate TxDOT to execute a Change Order or any other amendment to this Capital Maintenance Contract. TxDOT will acknowledge receipt of each Form 1295 submitted by DB Contractor in relation to each amendment to the CMC Documents, including each Change Order and Deviation, executed by TxDOT; however, TxDOT’s receipt of a Form 1295 shall not be construed as TxDOT’s review, approval, consent or certification as to the contents of such Form 1295, for which DB Contractor is solely responsible. Additional information regarding Form 1295 may be found at the Texas Ethics Commission website at xxxxx://xxx.xxxxxx.xxxxx.xx.xx/tec/1295-Info.htm.
Certificate of Interested Parties. Effective January 1, 2016, pursuant to House Xxxx 1295 passed by the 84th Texas Legislature (Section 2252.908, Texas Government Code, as amended) and formal rules released by the Texas Ethics Commission (TEC), all contracts with private business entities requiring approval by the Schertz City Council will require the on-line completion of Form 1295 "Certificate of Interested Parties." Form 1295 is also required for any and all contract amendments, extensions or renewals. Contractors are required to complete and file electronically with the Texas Ethics Commission using the online filing application. Please visit the State of Texas Ethics Commission website, xxxxx://xxx.xxxxxx.xxxxx.xx.xx/whatsnew/elf_info_form1295.htm and xxxxx://xxx.xxxxxx.xxxxx.xx.xx/tec/1295-Info.htm for more information. IF YOU HAVE ANY QUESTIONS ABOUT COMPLIANCE, PLEASE CONSULT YOUR OWN LEGAL COUNSEL. COMPLIANCE IS THE INDIVIDUAL RESPONSIBILITY OF EACH PERSON OR AGENT OF A PERSON WHO IS SUBJECT TO THE FILING REQUIREMENT. AN OFFENSE UNDER CHAPTER 176 IS A CLASS C MISDEMEANOR. [The remainder of this page is intentionally left blank.] EXECUTED on this the day of , 20 .
Certificate of Interested Parties. Engineer will comply with the provisions of Section 2252.908 of the Texas Government Code and Chapter 46 of the Texas Ethics Commission Rules by preparing a Texas Form 1295, “Certificate of Interested Parties” and submitting the signed and notarized form to PCCA at the time Engineer submits the signed Agreement to PCCA. A separate Form 1295 may be required for subsequent Service Orders, as required by the referenced code and rules issued thereunder.
Certificate of Interested Parties. Contractor agrees to comply with Texas Government Code Section 2252.908, as it may be amended, and to complete Form 1295 “Certificate of Interested Parties” as part of this Agreement.
Certificate of Interested Parties. (Form 1295) DB Contractor must file a Form 1295, Certificate of Interested Parties (“Form 1295”) with the Texas Ethics Commission as required by Section 2252.908 of the Texas Government Code and Chapter 46 of Title 1 of the Texas Administrative Code (collectively, the “Form 1295 Laws”) in connection with each amendment to this Capital Maintenance Agreement, including any Change Order or Deviation. DB Contractor must indicate the CSJ for this Agreement and the applicable Change Order, Deviation or amendment number in the fields provided on Form 1295. As a condition to TxDOT's execution of any amendment to this Capital Maintenance Agreement, including a Change Order or Deviation, DB Contractor must submit to TxDOT an executed and notarized Form 1295 complying with the requirements of the Form 1295 Laws at the same time it submits the executed amendment, including any Change Order or Deviation, for TxDOT's execution. TxDOT will not execute any Change Order or other amendment to this Capital Maintenance Agreement until it has received the Form 1295 completed in accordance with this Section 10.4.6 and the Form 1295 Laws; provided, that DB Contractor’s filing of a Form 1295 does not obligate TxDOT to execute a Change Order or any other amendment to this Capital Maintenance Agreement. TxDOT will acknowledge receipt of each Form 1295 submitted by DB Contractor in relation to each amendment to this Capital Maintenance Agreement executed by TxDOT; however, TxDOT's receipt of a Form 1295 shall not be construed as TxDOT's review, approval, consent or certification as to the contents of such Form 1295, for which DB Contractor is solely responsible. Additional information regarding Form 1295 may be found at the Texas Ethics Commission website at xxxxx://xxx.xxxxxx.xxxxx.xx.xx/tec/1295-Info.htm.
Certificate of Interested Parties. (Form 1295) must be provided by the Selected Contractor per the Texas Legislature adoption of House Xxxx 1295 which added section 2252.908 of the Government Code. Selected Contractor must submit the completed form prior to the City Council Meeting to award the project.
Certificate of Interested Parties. House Bill 1295, adopted by the 84th Legislature, created §2252.908, Texas Government Code. Section 2252.908 requires a business entity entering into certain contracts with a governmental entity or state agency to file with the governmental entity or state agency a disclosure of interested parties at the time the business entity submits the signed contract to the governmental entity or state agency. Section 2252.908 requires the disclosure form to be signed by the authorized agent of the contracting business entity, acknowledging that the disclosure is made under oath and under penalty of perjury. Section 2252.908 applies only to a contract that requires an action or vote by the governing body of the governmental entity or state agency before the contract may be signed or has a value of at least $1 million. Instructions for completing Form 1295 are available at: xxxxx://xx.xxxxxxx.xx.xx/departments/purchasing/vendor-information
Certificate of Interested Parties. Texas Legislature House Xxxx 1295, which added section 2252.908 of the Government Code. The law states that a governmental entity or state agency may not enter into certain contracts with a business entity unless the business entity submits a disclosure of interested parties to the governmental entity or state agency at the time the business entity submits the signed contract to the governmental entity or state agency. The law applies only to a contract of a governmental entity or state agency that either (1) requires an action or vote by the governing body of the entity or agency before the contract may be signed or (2) has a value of at least $1 million, or (3) is for services that would require a person to register as a lobbyist under Chapter 305 of the Government Code. Additional information and the form to be used to file this notice can be found at: xxxxx://xxx.xxxxxx.xxxxx.xx.xx/filinginfo/1295/
Certificate of Interested Parties. FORM 1295
