4-04 - Form 1295 Certificate of Interested Parties.pdf

This document is a House Bill 1295 Certificate of Interested Parties (Form 1295), which is a standard state government disclosure form for business entities entering into contracts with governmental entities. The form requires businesses to disclose interested parties when filing a contract, with sections for identifying the business entity, the governmental entity, and any parties with a controlling or intermediary interest in the contract. The form is designed to provide transparency about potential conflicts of interest or business relationships in state government contracting.

The form includes several blank sections that must be completed, including spaces to list the name and location of interested parties, their nature of interest (controlling or intermediary), and an unsworn declaration section to be signed by an authorized agent. The form allows for additional pages to be added as necessary to fully disclose all relevant parties. It is part of a state-level compliance mechanism to ensure openness and accountability in government contracting processes, requiring detailed information about business relationships and potential influencers in state contract awards.