6-Attachment No. 8 Form 1295.pdf

Attachment No. 8 Instructions for completing form 1295

Texas Government Code Section 2252.908 requires any business entity that enters into a contract with a governmental entity, like a public community college, to file a Form 1295 naming the people with a controlling interest in the business entity. While the law was designed more for procurement and vendors, the statute applies to any contract which requires Board approval, which would include this Sale and Purchase Contract.

The statute also includes disclosing the controlling interests of intermediaries like brokers, attorneys, and law firms who assisted in the negotiation of the contract. A controlling interest in the business is anyone with a 10% ownership interest, board members if the board has 10 or fewer members, and officers (if four or fewer officers) or the four most highly compensated officers (if the business has more than four officers) – their names must be listed on the form. So the Seller and the Seller’s attorney and broker, if any, will have to complete the process (naming everyone with a controlling interest in the form). This form does not apply to publicly traded business entity (if this exception is applicable to the entity contracting with the governmental entity, submit a signed statement that the 1295 Disclosure Form is not applicable and the reason).

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/whatsnew/elf_info_form1295.htm.

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.

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

https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm http://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm https://www.ethics.state.tx.us/whatsnew/elf_info_form1295.htm

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

FORM 1295CERTIFICATE OF INTERESTED PARTIES

OFFICE USE ONLOFFICE USE ONLOFFICE USE ONLOFFICE USE ONLOFFICE USE ONLYYYYY

6 UNSWORN DECLARATION

My name is _______________________________________________________, and my date of birth is _______________________________.

My address is ________________________________________________, ___________________, _______, __________, ______________.

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

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

Executed in ___________________ County, State of ______________ , on the _______ day of _______________, 20______.

(month) (year)

Signature of authorized agent of contracting business entity (Declarant)

ADD ADDITIONAL PAGES AS NECESSARY

Name of Interested Party Nature of Interest (check applicable)City, State, Country

(place of business) Controlling Intermediary

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

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.

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.

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

Check only if there is NO Interested Party.

M us t f ile on lin e at w w w .e th ic s.

st at e.

tx .u s/ File