WA18-02 CS091218 CERTIFICATE OF INTERESTED PARTIES FORM 1295
1of1
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
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2018-403269
Alan Plummer Associates, Inc.
Fort Worth,TX United States oate Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 09/12/2018
being filed.
Cityof Coppell 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 services,goods,or other property to be provided under the contract.
2017-178-00
Coppell Asset Management Phase 1
Nature ofinterest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Coonan, Steve Austin,TX United States X
Hunt, Rex Austin, TX United States X
Tucker,Alan Dallas, TX United States X
Caffey, Jeffrey Fort Worth, TX United States X
Davis, Alan Fort Worth, TX United States X
Gudal, David Fort Worth,TX United States X
McDonald, Ellen Fort Worth,TX United States X
Young, Chris Fort Worth, TX United States X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is Tammy Kilhullen , and my date of birth is ��r°1`7 l ����
My lddres5 is 1320 S.Universiry Drive Fort Worth TX , 76107 , USA
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in Tarrant County, State of Texas ,on the 12 day of September,20 18 _
(month) (year)
Signa r of thorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.6711