ESBD_533994_1783002895210_04. Texas Family Code Schedule.docx

DOCX document 37 KB Posted

Attached to
Wavetronix SmartSensors
Solicitation number
601310000101833
Issued by
Texas

About this file

This is a Texas Family Code Schedule form required for solicitation number 601310000101833 related to a Wavetronix SmartSensors contract opportunity in Texas. The document serves as a certification of eligibility regarding child support obligations under Texas Family Code Section 231.006. Respondents must complete the schedule by providing names and Social Security numbers for all individuals or business entities holding at least twenty-five percent ownership interest in the submitting organization. The form requires respondent attestation that all named parties are eligible to receive payment under the contract and acknowledges that the contract may be terminated and payment withheld if the certification is found to be inaccurate.

The schedule must be signed and returned with the response submission, as failure to do so may result in the response being deemed non-responsive. Respondents who do not meet the ownership criteria under Texas Family Code Section 231.006 may check an applicable box to indicate the schedule is not applicable. Social Security numbers are collected pursuant to the Federal Privacy Act and will be used to identify persons owing child support obligations; this information will be maintained confidentially to the fullest extent permitted under Texas Family Code Section 231.302(e).

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TEXAS FAMILY CODE SCHEDULE

SOLICITATION NO. 601310000101833

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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