Common use of Certificate of Interested Parties Clause in Contracts

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brainfuse, Inc. Certificate Number: 2022-912878 New York, NY United States Date Filed: 07/20/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 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. B22-002 Online Homework Tutor 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brainfuse, Inc. Fort Bend Green Certificate Number: 20222021-912878 New York826180 Sugar Land, NY TX United States Date Filed: 07/20/2022 11/22/2021 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 12/07/2021 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. B22-002 Online Homework Tutor 19898 Facilitate the development of Public Parks and Recreational Lands 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brainfuse, Inc. MPACT Strategic Consulting LLC Certificate Number: 20222023-912878 New York1046409 Houston, NY TX United States Date Filed: 07/20/2022 07/14/2023 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 08/08/2023 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. B22-002 Online Homework Tutor Triple R Grant Prog Monitoring Monitoring & Compliance Oversight of Triple R 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. BrainfuseXxXxxxxx Building Maintenance, Inc. Certificate Number: 20222024-912878 New York1107869 HOUSTON, NY TX United States Date Filed: 07/20/2022 01/02/2024 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 01/23/2024 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. B22-002 Online Homework Tutor TIPS 230103 Janitorial Services for Justice Center 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. BrainfuseBoys & Girls Clubs of Greater Houston, Inc. Certificate Number: 20222023-912878 New York1093061 Houston, NY TX United States Date Filed: 07/20/2022 11/09/2023 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 11/21/2023 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. B2214305 23-002 Online Homework Tutor Parks-100245-A1 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brainfuse, Inc. Yellowstone Landscape Certificate Number: 2022-912878 New York948243 Houston, NY TX United States Date Filed: 07/20/2022 10/25/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 11/01/2022 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. B22-002 Online Homework Tutor COOP #20/030MR ROW Mowing utilizing Choice Partners COOP #20/030MR 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. BrainfuseBIO-WEST, Inc. Certificate Number: 20222021-912878 New York707365 Rosenberg, NY TX United States Date Filed: 07/20/2022 01/19/2021 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 02/09/2021 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. B22-002 Online Homework Tutor SOQ 14- 025 Environmental Consulting 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. BrainfuseTETRA TECH, Inc. INC. Certificate Number: 20222023-912878 New York1070868 Houston, NY TX United States Date Filed: 07/20/2022 09/12/2023 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County County, Texas Date Acknowledged: 08/23/2022 09/26/2023 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. B22RFP 19-002 Online Homework Tutor 041 CONTINGENCY ALL HAZARDS CONSULTING SERVICES 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brainfuse, Inc. Buckeye Technology Solutions d.b.a. CCS Presentation Systems Certificate Number: 20222024-912878 New York1122936 Houston, NY TX United States Date Filed: 07/20/2022 02/12/2024 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 02/27/2024 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. B22RFP 23-002 Online Homework Tutor 019 Courtroom AV Upgrade 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brainfuse, Inc. Yellowstone Landscape Certificate Number: 20222023-912878 New York1079115 Houston, NY TX United States Date Filed: 07/20/2022 10/03/2023 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 10/24/2023 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. B22-002 Online Homework Tutor 20/030MR ROW Mowing 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brainfuse, Inc. Teal Construction Company Certificate Number: 2022-912878 New York903090 Houston, NY TX United States Date Filed: 07/20/2022 06/23/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 07/05/2022 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. B22RFP 21-002 Online Homework Tutor 078 FBC Jail Repairs & Renovations 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. BrainfuseSHI Government Solutions, Inc. Certificate Number: 2022-912878 New York840117 Austin, NY TX United States Date Filed: 07/20/2022 01/14/2022 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Date Acknowledged: 08/23/2022 02/08/2022 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. B2222-002 Online Homework Tutor IT-100511 Cartegraph OMS Premium for Road & Bridge 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx

Certificate of Interested Parties. FORM 1295 1 of 1 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. OFFICE USE ONLY CERTIFICATION OF FILING 1 Name of business entity filing form, and the city, state and country of the business entity's place of business. Brainfuse, Inc. Certificate Number: 20222021-912878 New York745820 Missouri City Jaguars Football & Cheer Houston, NY TX United States Date Filed: 07/20/2022 04/30/2021 2 Name of governmental entity or state agency that is a party to the contract for which the form is being filed. Fort Bend County Parks & Recreation Department Date Acknowledged: 08/23/2022 09/28/2021 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. B22-002 Online Homework Tutor 123456 Football games, cheerleading 4 Name of Interested Party City, State, Country (place of business) Nature of interest (check applicable) Controlling Intermediary 5 Check only if there is NO Interested Party. X 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) Forms provided by Texas Ethics Commission xxx.xxxxxx.xxxxx.xx.xx