ATTM 004.docx

This is a Disclosure and Control Interest Statement form related to state and local contracting requirements. The document serves as a certification mechanism for disclosing financial interests, ownership stakes, and control relationships relevant to contract eligibility and compliance purposes. The statement requires disclosure of all parties with direct or indirect ownership interests, control of operations, or financial participation in the contracting entity. The form includes multiple sections for identifying principals, officers, stockholders, partners, and other stakeholders with material interests in the organization submitting the bid or proposal. Supporting documentation and detailed schedules are referenced through accompanying images to provide comprehensive disclosure of organizational structure and financial relationships.

The form functions as a compliance and transparency tool designed to ensure that all relevant financial interests and control relationships are documented for public contracting purposes. It requires certification by authorized representatives and includes provisions for disclosing any changes in ownership or control that may affect contract performance or eligibility. The statement may be required for bid submission, contract award, or ongoing contract administration depending on the specific jurisdictional requirements. Completion and submission of this disclosure document is typically mandatory for contractors seeking to participate in state and local procurement opportunities, with false or incomplete statements subject to contract termination or other penalties.