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<br /> 1//£ <br /> rU'~ f'omt C32-A <br /> .. ,~-- ~ NONGOVERNMENT AL .~NTRAcrOR CERTIFICATION (pART II) ~ 1 g!j () <br /> .U . cond1tion fof' nteeMng . ...uuh-.:1 Of' haYing ~ renewed, potential contractora who answered '<yes" to either or both <br /> of the questions on fom1 <4732 must ~ the questi0n8 on ,tiú8 form (Form <4732-A). The questions must be fully answered <br /> Jnd the certIfication on Page 2 must be completed and signed. The answers are used to screen potential contradOf'S according <br /> 10 requJrements In the smte appropriations act (S.S. 222, 71st Legis!atut'e, Regular Seaton, 19s9), Texas Reviaed eMl Statutes, <br /> Art. 5547-202. Sec. 2.<45. 8nd Texas Department of Human SeC'Vic8S (DHS) ndes found In the Texas Adm. Code, 11tie <4Q, Part 1, <br /> Chapter 79,SS79.1801-~.1801. <br /> 1. REGARDING PAST AHD CURRENT DHS EMPLOYEES AND BOARD ~RS= --- "--"-' .. <br /> Did you answer "yes" 80 q"-"ãtvt 1 aø. Form <47321 -.. .. ....... - . .. ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes ONo <br /> ff "CIC,." 8iàp to q41nf1iør1 %. Jr -,... - o....~Ðe the ~Å ~ fnfbnn8tion for thòSe persons. If they are FORMER OHS employees, <br /> fnt4t.-..me.whether anodatfon with the potential contractor resulted In a 2S~ or nt<H'e Ina-eae in overall annual beneftt$ (including <br /> .. I) over what was received when the person was with DHS. <br /> ~ 04 Pe<son ~ ..wn f'oI8ntiaJ ConcnIdor I L.atfCun'8nt PoIition Held at OHS Begin. OeM at OHS . ending Dale <br /> ~ Area at DHS I CunwI1 PoIition with ~ Conttw::Ior I Begin."1ing 08!e 25* or More inctwue in Compensation <br /> Dyes DNa <br /> Name of Pef"SOn Associated wittI f'1: (entiaJ Contr8dDt I ~ Pœition Held at DHS Begin. Date at OHS . EndIng Date <br /> P~ Area at DHS I CurTent PosItion wittI ~entiaI ~ . .¡Beginning Dat. 25'MI 0( Mont inc:r--.. in Compensatton <br /> Dyes DNa <br /> - <br /> Name of Person "nociated W1th Potenl18l Contracto< 1.ast/CufNnt Pœiùoo Held at DHS Begin. Date at DHS . Ending Date <br /> Prograrn/Support Area at DHS I Current Position with Potentl8l Contradof I Beginning Date 2S% or More increase in CompensatIOn <br /> Dyes DNa <br /> ~ - <br /> 2. REGARDING THOSE ASSOCIATED WITH POTENTIAL CONTRACTORS AND THE ASSOCIATES' RELATIVES- <br /> Did you answer "yes" to question 20n Form 4732?.................. ..... ....... .... ......,....... .... Dyes DNo <br /> If "no," skip to question 3. If "yes," complete the following Information for those persons and their relatives. <br /> Name of Person AsSOC1&ted WTth Potential Contractor Cumtnt Position wtth Potential Contractor 8egmnlng Date. .' <br /> Name of CurTentIForme< DHS Employeef6oará Member Relationship to Petson Associated with f'1: (ential Contractor <br /> ï: :urrent POSlloon ~ at DHS (uS<! DHS OO title. if possù)Ie) Program/Suppo<1 Area at DHS !Begin. Date at DHS . EndIng Date <br /> I <br /> -u <br /> Name of Person AssocIated Wllrt Potential Contractor Current POSitIOn WIth PotentaaJ Contractor I BeginnIng Date <br /> Name of CurrenttFormer DHS Em~n:! MemOe< Rel.atoonstu;l to Par$OO Assooated with Potential Contractor <br /> Last/CurTent POSlhon HeIa at DHS (use DHS OÒ title. if possible) Prograrn/Support Area at DHS 1 Begin. Date at DHS . Ending Date <br /> Name of Person Asscc<ated Wltrt Potential Contractor Current PosrtIOn WIth Potentl8l Contractor I Beg1nnlng Date <br /> Name of CurrentIFormer OHS EmployHiB08ré Member RetatlOnstup to Person Assoc2ated with Potentia] Contractor <br /> LastlCurrent Pos<toon Held at DHS (use DHS OÒ trtIe. if possible) PrograrnlSupport Are.¡¡ at OHS I Begin. o.te at DHS . Ending Date <br /> continued on back <br />