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CERTIFICATE OF INTERESTED PARTIES FORM 1295 <br />lofl <br />ComCompd 6 if <br />Complete Nos. 1, 2, anand there if thereinterested are partted parties. � � � �� �� CERTIFICATION E USE <br />OF FILING <br />1 Name of business entity filing form, and the city, state and ���-� <br />s country of the business entity's place Certificate Number: <br />of business. 2025-1292938 <br />Richard Drake Construction <br />Paris, TX United States Date Filed: <br />2" Name of goverrimenf � entity or state agency Yhat is a pang to type contract for-w)tic6i the form is - " 04/08/2025 <br />being filed. <br />City of Paris Date Acknowledged: <br />description of the services, Dods, or by the governmental entity or state agency to track or identify <br />www�w <br />3 Provide the identification number used dentify the contract, and provide a <br />p g other property to be provided under the contract. <br />Concrete Demo and Construction <br />Curb/gutter, standard driveway approaches, valley gutters, and sidewalks <br />_. .......... .------ �.. . .._...__....... ..................... _....___ - <br />Nature of interest <br />4 <br />Name of Interested Party � City, State, Country (place of business) check applicable) <br />Controlling Intermediary <br />�......_..ri ......._........ <br />5 Check only if there is NO Interested Party. ❑ <br />X <br />wa _....._.............. ............ ....k., ._ _..... .. _..._.. ...�........ <br />6 UNSWORN DECLARATION <br />My name is . . � ^ , _ _,® and my date of birth is4n <br />.a„ <br />My address is ) 1' i.Z 12 <br />_• '�%J� <br />(street) (city) {state) (zip code) (country) <br />I declare under penalty of perjury that the foregoing is true and correct. <br />Executed in �pk ......:. ®,,,,,,,,, County, State of 'T;:XA S on the day of i1. _ 2D 7.5. <br />(month) {year) <br />Signature of authorized agent of contracting business entity <br />(Declarant) <br />Forms provided by Texas Ethics Commission W www.ethics.state.tx.us WW Version V4.1.0.e02d622 <br />1 <br />