ESBD_521437_1780090208639_04. Texas Family Code Schedule.docx

DOCX document 38 KB Posted

Attached to
MD30 Mobile Road Sensor
Solicitation number
601340000065147
Issued by
Cherokee County, Texas

About this file

This is a Texas Family Code Schedule form for Solicitation No. 601320000065147, issued by the State of Texas to establish eligibility requirements for respondents seeking state contract payments. The schedule requires all respondents to certify compliance with Texas Family Code Section 231.006 regarding child support obligations and to disclose ownership information for any individual or business entity holding at least twenty-five percent ownership interest in the submitting business entity. Respondents must provide the names and Social Security numbers of all qualifying owners, or alternatively, indicate that the ownership threshold does not apply to their entity. The form must be completed, signed, and returned with the response submission.

Failure to sign and return this schedule may result in the response being deemed non-responsive and may lead to contract termination and payment withholding if the certification is found to be inaccurate. The disclosure of Social Security numbers is required under Texas Family Code Sections 231.006(c) and 231.302(c)(2) for the purpose of identifying individuals who may owe child support obligations. Per the Federal Privacy Act Notice, such information will be kept confidential to the fullest extent permitted under Section 231.302(e) of the Texas Family Code.

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Text version

TEXAS FAMILY CODE SCHEDULE

SOLICITATION NO. 601320000065147

Ineligibility to Receive State Grants or Loans or Receive Payment on State Contracts Respondent shall fill out the appropriate information, sign and return the schedule.

Under Family Code §231.006, relating to child support obligations, Respondent and any other individual or business entity named in this solicitation are eligible to receive the specified payment and acknowledge that this contract may be terminated and payment withheld if this certification is inaccurate. Any response submitted under this solicitation shall contain the names and social security numbers of person or entity holding at least a twenty-five percent ownership interest in the business entity submitting the response. Respondents meeting the ownership must complete the following:

Click or tap here to enter text.XXX-XX-Click or tap here to enter text.
NameSocial Security Number
Click or tap here to enter text.XXX-XX-Click or tap here to enter text.
NameSocial Security Number
Click or tap here to enter text.XXX-XX-Click or tap here to enter text.
NameSocial Security Number

If the respondent does not meet the ownership criteria under Texas Family code - Section 231.006, check the box below, sign and return the schedule.

☐ This Schedule is not applicable FEDERAL PRIVACY ACT NOTICE: This notice is given pursuant to the Federal Privacy Act. Disclosure of your Social Security (SSN) is required under Section 231.006(c) and Section 231.302(c)(2) of the Texas Family Code. The SSN will be used to identify persons that may owe child support. The SSN will be kept confidential to the fullest extent allowed under Section 231.302(e), Texas Family Code.

Signature Name Click or tap here to enter text.

Title Click or tap to enter a date.

THIS PAGE MUST BE RETURNED WITH THE RESPONSE. FAILURE TO SIGN AND RETURN THIS PAGE MAY RESULT IN THE RESPONSE BEING CONSIDERED NON-RESPONSIVE.

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