Common use of Certificate of Interested Parties Clause in Contracts

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. Buckeye Technology Solutions d.b.a. CCS Presentation Systems Certificate Number: 2024-1122936 Houston, TX United States Date Filed: 02/12/2024 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: 02/27/2024 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. RFP 23-019 Courtroom AV Upgrade 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 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. Buckeye Technology Solutions d.b.a. CCS Presentation Systems IDG Architects, Inc. Certificate Number: 2024-1122936 Houston1164873 HOUSTON, TX United States Date Filed: 02/12/2024 05/22/2024 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: 02/27/2024 05/28/2024 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. RFP 23-019 Courtroom AV Upgrade 100616 Design Services - Rosenburg Senior Activity Center with Natatorium 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 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. Buckeye Technology Solutions d.b.a. CCS Presentation Systems Boys & Girls Clubs of Greater Houston, Inc. Certificate Number: 20242023-1122936 1093061 Houston, TX United States Date Filed: 02/12/2024 11/09/2023 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: 02/27/2024 11/21/2023 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. RFP 14305 23-019 Courtroom AV Upgrade Parks-100245-A1 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 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. Buckeye Technology Solutions d.b.a. CCS Presentation Systems Yellowstone Landscape Certificate Number: 20242022-1122936 948243 Houston, TX United States Date Filed: 02/12/2024 10/25/2022 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: 02/27/2024 11/01/2022 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. RFP 23-019 Courtroom AV Upgrade COOP #20/030MR ROW Mowing utilizing Choice Partners COOP #20/030MR 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 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. Buckeye Technology Solutions d.b.a. CCS Presentation Systems Certificate Number: 20242021-1122936 745820 Missouri City Jaguars Football & Cheer Houston, TX United States Date Filed: 02/12/2024 04/30/2021 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 Parks & Recreation Department Date Acknowledged: 02/27/2024 09/28/2021 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. RFP 23-019 Courtroom AV Upgrade 123456 Football games, cheerleading 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