ESBD_399645_1740777051395_Form 1295 Sample - Texas-Ethics-Commission-Conflict-of-Interest.pdf
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- Attached to
- FANS Full Line Grocery
- Solicitation number
- 2025-05-27-009
- Issued by
- Texas
About this file
This is a Certificate of Interested Parties (Form 1295) template from the Texas Ethics Commission for use with Plano Independent School District contracts. The form requires vendors to disclose interested parties in contracts with governmental entities, with specific fields for the business entity's information, contract identification details, and declarations of interested parties.
The form must be completed electronically through the Texas Ethics Commission's website (https://www.ethics.state.tx.us/filinginfo/1295/index.php#efa_collapse1) and cannot be filled out by hand. It requires disclosure of controlling and intermediary interested parties, their locations, and nature of interest. The form includes an unsworn declaration section that must be completed by an authorized agent of the contracting business entity. No specific pricing terms or contract values are mentioned in this document, as it is purely a disclosure form required for contract compliance.
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Text version
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.
Complete this section with your Company's information
Name of governmental entity or state agency that is a party to the contract for which the form is being filed.
Plano Independent School District
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.
Plano ISD's RFP/CSP or Contract No. < insert number here > <insert description here>
Certificate Number:
Date Filed:
Date Acknowledged:
CERTIFICATION OF FILING
Signature of authorized agent of contracting business entity
My name is _______________________________________________________________, UNSWORN DECLARATION
Check only if there is NO Interested Party.5
My address is _______________________________________________, _______________________, and my date of birth is _______________________.
Executed in ________________________________________County, I declare under penalty of perjury that the foregoing is true and correct.
(street) (state) (zip code) (country)
(year)(month)
State of ________________, on the _____day of ___________, 20_____.
(city)
(Declarant)
Version V1.0.3337www.ethics.state.tx.usForms provided by Texas Ethics Commission
SAMPLE ONLY!
DO NOT COMPLETE SECTIONS 1-5 BY HAND
Vendor must prepare Form 1295 electronically, on Texas Ethics Commission’s website:
https://www.ethics.state.tx.us/filinginfo/1295/index.php#efa_collapse1
This s ection will auto-populate
File details come from the government source that posted it. Updated .