5-4. DISD Certificate of Interested Parties - Form 1295 Guidance.pdf
PDF 365 KB Posted
- Attached to
- Public Insurance Adjusting Firm
- Solicitation number
- BP-250054
- Issued by
- Dallas County, Texas
About this file
This file is guidance documentation from Dallas Independent School District (DISD) regarding the Certificate of Interested Parties (Form 1295) requirement for contract proposals. The form is mandated by Texas House Bill 1295, which amended the Texas Government Code Section 2252.908 to require disclosure of interested parties in contracts resulting from DISD solicitations. All vendors submitting proposals must electronically complete Form 1295 through the Texas Ethics Commission's online filing application, print the completed form with its certification of filing number, obtain authorized signature, and include the signed form with their proposal response, regardless of whether interested parties exist. An "interested party" is defined as a person who has a controlling interest in the business entity or who actively participates in facilitating or negotiating the contract, including brokers, intermediaries, advisers, or attorneys. DISD must acknowledge receipt of Form 1295 to the Texas Ethics Commission within 30 days of contract execution, after which the form will be posted to the Commission's website within seven business days.
The guidance document applies to the Public Insurance Adjusting Firm RFP, a district-wide procurement for licensed public insurance adjusting firms to provide claims recovery services on an "as needed" basis for any Dallas ISD facilities. The contract term consists of an initial three-year agreement with two optional successive one-year extensions, not to exceed five years total, with either party required to provide written notice 90 days prior to expiration if they do not intend to renew. The procurement complies with Title 2 of the Code of Federal Regulations Part 200 requirements and may utilize local, state, federal, and grant-funded program dollars. The Texas Ethics Commission provides instructional videos and FAQs to assist first-time business users in completing and filing Form 1295.
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9400 N. CENTRAL EXPRESSWAY | DALLAS, TEXAS 75231 | 972.925.3700 | WWW.DALLASISD.ORG
CERTIFICATE OF INTERESTED PARTIES – 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 included in proposal response.)
DISD 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 DISD from entering into a contract resulting from this solicitation with a business entity unless the business entity submits a Disclosure of Interested Parties (Form 1295) to DISD 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 DISD 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 https://www.ethics.state.tx.us/filinginfo/1295/ Proposers 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.
The completed Form 1295 with the certification of filing must be filed with DISD by including the completed form in the proposal response.
DISD must acknowledge the receipt of the filed Form 1295 by notifying the Texas Ethics Commission of the receipt of the filed Form 1295 no later than the 30th day after the date the contract binds all parties to the contract. After DISD acknowledges the Form 1295, the Texas Ethics Commission will post the completed Form 1295 to its website within seven business days after receiving notice from
DISD.
Link for FAQ’s and further information regarding certification requirement:
https://www.ethics.state.tx.us/resources/FAQs/FAQ_Form1295.php#Q3
Instructional Video – First Time Business User:
• https://www.ethics.state.tx.us/filinginfo/videos/Form1295/FirstLogin-Business/Form1295Login- Business.html
Instructional Video – How to Create a Certificate:
• https://www.ethics.state.tx.us/filinginfo/videos/Form1295/CreateCertificate/CreateCertificate.html https://www.ethics.state.tx.us/filinginfo/1295/ https://www.ethics.state.tx.us/resources/FAQs/FAQ_Form1295.php#Q3 https://www.ethics.state.tx.us/filinginfo/videos/Form1295/FirstLogin-Business/Form1295Login-Business.html https://www.ethics.state.tx.us/filinginfo/videos/Form1295/FirstLogin-Business/Form1295Login-Business.html https://www.ethics.state.tx.us/filinginfo/videos/Form1295/CreateCertificate/CreateCertificate.html
Controlling Name of Interested Party
Nature of interest
City, State, Country (place of business) Intermediary
(check applicable)
CERTIFICATE OF INTERESTED PARTIES 1295FORM
OFFICE USE ONLY
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.
Name of business entity filing form, and the city, state and country of the business entity's place of business.
Name of governmental entity or state agency that is a party to the contract for which the form is being filed.
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.
Certificate Number:
Date Filed:
Date Acknowledged:
CERTIFICATION OF FILING
Signature of officer administering oath
AFFIX NOTARY STAMP / SEAL ABOVE
Signature of authorized agent of contracting business entity
Title of officer administering oath
I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Sworn to and subscribed before me, by the said _____________________________________, this the ____________ day of ______________, 20________, to certify which, witness my hand and seal of office.
AFFIDAVIT
Printed name of officer administering oath
Check only if there is NO Interested Party.5
Version V1.0.645www.ethics.state.tx.usForms provided by Texas Ethics Commission
Kevin Klas Void
Kevin Klas Information Only
| 4. DISD Certificate of Interested Parties - Form 1295 Guidance |
| Certificate of Interested Parties (Form 1295 – must be filled out electronically with the Texas Ethics Commission’s online filing application, printed out, signed, and included in proposal response.) |
| As a “business entity,” all vendors must electronically complete, print, sign, and submit Form 1295 with their proposals even if no interested parties exist. |
1295 Sample
File details come from the government source that posted it. Updated .