ESBD_482029_1767999988551_Attachment F- 1295 Certificate of Interested Parties Form.pdf
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- Solicitation number
- 781-6-04389
- Issued by
- Travis County, Austin City, Texas
About this file
This is a Certificate of Interested Parties Form 1295 provided by the Texas Ethics Commission, required for state and local contract opportunities in Texas. The form serves as a disclosure document that contracting business entities must file to identify any interested parties associated with a contract. The form requires completion of specific sections depending on whether interested parties exist: if interested parties are present, the filer must complete sections 1 through 4 and 6; if no interested parties exist, sections 1, 2, 3, 5, and 6 must be completed. The form collects information about the contracting business entity's name, location, the governmental entity or state agency involved in the contract, the contract identification number, a description of services or goods to be provided, and the nature and details of any interested parties.
The form must be filed online through the Texas Ethics Commission's official portal at the designated web address. The declarant must provide an unsworn declaration under penalty of perjury, including personal identifying information such as name, date of birth, and address. Additional pages may be added as necessary to list multiple interested parties. This disclosure form is a mandatory compliance requirement for all contracts with Texas governmental entities and state agencies, ensuring transparency regarding party interests and relationships in state contracting matters.
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Text version
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 5/14/2025
Attachment F - CERTIFICATE OF INTERESTED PARTIES FORM 1295
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 .
Mus t fi le on lin e a t h ttp s:/ /pr d.t ec prd .et hic se file .co m/File
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