4-Form 1295 Instructions - How to Complete the Form.pdf

Instructions for Completing form 1295

Certificate of Interested Parties (Form 1295 – must be filled out electronically with the Texas Ethics Commission’s online filing application, printed out, signed, and submitted in the “Edgar” Request Information section in Bonfire)

FBISD is required to comply with House Bill 1295, which amended the Texas Government Code by adding Section 2252.908, Disclosure of Interested Parties. Section 2252.908 prohibits FBISD from entering into a contract resulting from this RFP with a business entity unless the business entity submits a Disclosure of Interested Parties (Form 1295) to FBISD at the time business entity submits the signed contract. The Texas Ethics Commission has adopted rules requiring the business entity to file Form 1295 electronically with the Texas Ethics Commission.

“Interested Party” means a person:

a) who has a controlling interest in a business entity with whom FBISD contracts; or

b) who actively participates in facilitating the contract or negotiating the terms of the contract, including a broker, intermediary, adviser, or attorney for the business entity.

“Business Entity” means an entity recognized by law through which business is conducted, including a sole proprietorship, partnership, or corporation.

As a “business entity,” all vendors must electronically complete, print, sign, and submit Form 1295 with their proposals even if no interested parties exist.

Proposers must file Form 1295 electronically with the Texas Ethics Commission using the online filing application, which can be found at 1295 Filing Info (state.tx.us) must use the filing application on the Texas Ethics Commission’s website to enter the required information on Form 1295. Proposers must print a copy of the completed form, which will include a certification of filing containing a unique certification number. The Form 1295 must be signed by an authorized agent of the business entity.

Please notify the Buyer immediately if you experience any problem while completing this document on the Texas Ethics Commission website.

http://www.ethics.state.tx.us/filinginfo/1295/index.php

CERTIFICATE OF INTERESTED PARTIES FORM 1295

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

1 Name of business entity filing form, and the city, state and country of the business entity's place of business.

VENDOR'S NAME

2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed.

FORT BEND INDEPENDENT SCHOOL DISTRICT

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.

FORT BEND ISD PROJECT NUMBER AND TITLE

Name of Interested Party City, State, Country

(place of business) Nature of Interest (check applicable)

Controlling Intermediary

Peter James Missouri City, TX United States X

Vend rs must complete this form electronica ly on the T xas Ethics Commission's website locat d at www.ethics.state.tx.us/File

Check only if there is NO Interested Party.

6 UNSWORN DECLARATION

My name is Peter James , and my date of birth is 1-1-1960 .

My address is 2768 Missouri City Dr. , Missouri City TX USA , , , .

(street) (city) (state) (zip code) (country)

I declare under penalty of perjury that the foregoing is true and correct.

Executed in Fort Bend

County, State of Texas , on the 5 day of June , 20 22 .

(month) (year)

Must be handwritten signature

Signature of authorized agent of contracting business entity (Declarant)

ADD ADDITIONAL PAGES AS NECESSARY

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 12/22/2017 http://www.ethics.state.tx.us/File http://www.ethics.state.tx.us/