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Contract# <br /> <br />Firm/CompanY Name <br /> <br />BUSINES$ 0 WNEP~HIP <br />Section 231.006, Family Code, requires the Department to colleat tho nameS and social security number of <br />individuals owning 25% or more of the.business entity awarded this contract. <br /> <br />l. In thc space$ below please provide the names and social security number of individuals owning 25% or <br /> <br />· moro of tho busineSs <br /> .. NAME <br /> <br /> Bart gamar <br /> <br />SOCIAL SECUR/TY NUMBEK <br />.449-02-291 4 <br /> <br />2. Please cheek the box below if no individual owns 23% or more of the busineSs. <br /> [ ] No individual owns 25% or more of the busineSs. <br /> · ' · ' confidential and may be <br /> Except aa provided by Section 231.302(d), Famtly Code, a socral se~urttynumbor ~s <br /> dizclosed only for }~.e purpose of rezponding to a requeSt for information from an agency operating under the <br /> provisions of parts A and D to Title IV' of the federal Social Security Act (42 USC Section 601-617 and .651- <br /> 699). - <br /> Under section 231.006, Family Code, the Condor or i~pplicant certifies that tho individual or busineSs entity <br /> named in this con.ct, bkl. or application is eligible to receive tho ~ceified grant, loan, or payment and <br /> aelmowled~e~ that~chis contract may be terminated and payment may be withheld if this certification is <br /> inaccurate. <br /> The information must bo provided and returned with tho executed contract documents. Failure to furnish this <br /> inform~n will result in ~e contract being decl~recl in default and forfeiture of tho propo~sal guaranty. <br /> <br /> Bart Jaraar <br /> <br /> Pdnt limo <br /> <br />If this project is a Joint Venture, all parties to the joint venture must provide n completed form. <br /> <br /> <br />