14-HCC Ownership Disclosure Requirement.pdf
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- Solicitation number
- IFB 26-04
- Issued by
- Harris County, Texas
About this file
This document is an Ownership Interest Disclosure List form (Exhibit 1 to Attachment No. 2), which appears to be part of a larger contract or bid submission package. The form provides instructions for respondents to disclose detailed information about company members, contractors, and subcontractors, specifically requiring the listing of any individuals with an ownership interest of 10% or more in the company.
The form is structured with three columns - Name, Title, and Company Name - and includes space for the company's authorized representative to provide their company name, signature, title, and the date of submission. At the bottom of the form, there is a checkbox option to indicate if no ownership interest disclosures are being made. The document is page 6 of 13, suggesting it is part of a more comprehensive solicitation or contract document, though the specific details of the overall contract are not included in this exhibit.
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Text version
EXHIBIT 1 TO ATTACHMENT NO. 2
OWNERSHIP INTEREST DISCLOSURE LIST
Instruction: Using the following table, please fill in the names of any member of the Respondent’s company who is a “Contractor” (as defined in Section 5 above); any person with an ownership interest of 10% or more; and any Subcontractor listed on the “Contractor and Subcontractor Participation Form.”
Name Title Company Name
Company Name: _____________________________________________________________________
Authorized Company Representative: ___________________________________________________
Authorized Representative’s Title: _______________________________________________________
Authorized Representative’s Signature: ___________________________________________________
Date: ____________________________________________________________________________
If NO Ownership Interest Discloser has been stated above, check
BALANCE OF PAGE INTENTIONALLY LEFT BLANK.
File details come from the government source that posted it. Updated .