Contract - Progressive Commerical Acquatics, Inc. - 2/25/2016CERTIFICATE OF INTERESTED PARTIES
FORM 1295
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Complete Nos. 1- 4 and 6 if there are interested parties.
OFFICE USE ONLY
Complete Nos. 1, 2, 3, 5, and 6 if there are no interested parties.
CERTIFICATION OF FILING
Certificate Number:
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
2016-6787
Progressive Commercial Aquatics, Inc.
Manor, TX united States
Date Fled:
01/28/2016
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Round Rock
Date Acknowledged:
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 goods or services to be provided under the contract.
Rock n River
Re plaster and toys
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 AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct
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o�PFY PGen TERESA J. GAFFNER
My Commission Expires
goFy August 08, 2018 FE ` ' " L� �✓� V _
••,•••••.....................v...,,,,,,.,J // Signature of authorized agent of contracting business/entity
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AFFIX NOTARY STAMP / SEAL ABOVE L//
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Sworn to and subscribed before me, by the said �[ • &H4(-5 ,4 V / S this the day ofJff�U Ltd
20 , to certify which, witness my hand and seal of office. t
/l ,c f �7'63Li �/. /�FF/v F,2 %�'%�/y1 � • SS'is%
Signature of offjcr r adminis ring oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.34416
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Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.34416
CERTIFICATE OF INTERESTED PARTIES
FORM 3.295
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
Certificate Number:
2016-6787
Date Filed:
01/28/2016
Date Acknowledged:
02/03/2016
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
Progressive Commercial Aquatics, Inc.
Manor, TX United States
2 Name of governmental entity or state agency that is a party to the contract for which the form is
being filed.
City of Round Rock
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 goods or services to be provided under the contract.
Rock n River
Re plaster and toys
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
AFFIDAVIT I swear, or affirm, under penalty of perjury, that the above disclosure is true and correct.
Signature of authorized agent of contracting business entity
AFFIX NOTARY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said this the day of
20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.34416