4-1295 Example 1.pdf
PDF 570 KB Posted
- Solicitation number
- RFP #26-011 Elevator Maintenance, Inspection and Related Services
- Issued by
- Upton County, Texas
About this file
This is a declaration of controlling and intermediary interest form related to RFP 25001 for Cold Storage Services, filed with an unspecified state or local government entity. The form requires bidders to declare their company or business entity information, including name, city, state, and country of origin. The document establishes definitions for controlling interest—defined as ownership exceeding 10 percent, board membership in entities with no more than 10 members, or officer status in businesses with four or fewer officers—and intermediary interest, characterized by compensation from the business entity, direct communication with the governmental entity regarding the contract, and non-employee status. Respondents must complete sections identifying the declarant, date of birth, address, and signature, along with notarization by state official with specified date and location fields.
The form serves as a compliance and transparency mechanism for contract bidding, requiring disclosure of ownership structures and decision-making authority within bidding entities. It applies to publicly held business entities and their wholly owned subsidiaries, with specific carve-outs for officer disclosures. The document does not contain pricing information, set-asides, award dates, contract terms, or project-specific details beyond the RFP reference number and service category. This appears to be a template or example document designed for standardized use across multiple state and local procurement processes.
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Example Only
) check applicable (
Your Company/Business Entity Name, City, State, Country
Example RFP 25‐001 Cold Storage Services
`Person who has controlling interest in a business entity Controlling Interest‐ has an ownership interest or participating interest in a business entity by virtue of units, percentage, shares, stock, or otherwise that exceeds 10 percent;
is a member of the board of directors or other governing body of a business entity of which the board or other governing body is composed of not more than 10 members; or serves as an officer of a business entity that has four or fewer officers, or serves as one of the four officers most highly compensated by a business entity that has more than four officers.
Subsection (c) of this section does not apply to an officer of a publicly held business entity or its wholly owned subsidiaries.
Intermediary Interest:
receives compensation from the business entity for the person's participation;
communicates directly with the governmental entity or state agency on behalf of the business entity regarding the contract; and is not an employee of the business entity or of an entity with a controlling interest in the business entity.
and my date of birth is _______________________.
( street ) ( state ) ( zip code ) ( country )
( year ) ( month )
State of ________________, on the _____day of ___________, 20_____.
( city )
( Declarant )
File details come from the government source that posted it. Updated .