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HomeMy WebLinkAboutA+ Glass & MirrorCONFLICT OF INTEREST %UESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person doing business with the governmental entity. By law this questionnaire must be filled with the records administrator of the local government not later than the 7h business day after the date the person becomes aware of facts that require eie statement to be filed. See Section 176.006, Local Government Code. A person committs an offense if the i)erson violates Section 176.006, Local Government Code. An offense undetl this section is a Class C misdemeanor. 1. Name of person doing business with local governmental entity. I� .hieKi 2. .....firi,gsL '+ 114;(s4,- OFFICE 4.(.r..Qr OFFICE USE ONLY Date Received Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year for which an ac vity described in Section 176.006(a), Local Government Code, is pending and not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3. Describe each affiliation or busi ess relationship with an employee or contractor of the local governmental entity who makes recommendations to a local government officer of the local governmental entity with respect to expenditure Of money. ❑ Robert Alley, Fire Chief ❑ Steve Beachy, Parks & Rec ❑ Glenn Brown, City Manager ❑ Olivia Burnside, Inf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ David Massey, Electric ❑ Michael Clancey, Police Chief ❑ Lance Simms, Planning & Dev El John Woody, W/WW ❑ Charles Wood, Economic Dev ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Finance ❑ Charles McLemore, Public Works ❑ Charles McLemore, Public Works ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Special Projects ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: 4. Describe each affiliation or bus ness relationship with a person who is a local government officer and who appoints or employs a local g vernment officer of the local government entity that is the subject of this questionnaire. ❑ Ron Silvia, Mayor O Ron Gay, Place 3 ❑ David Ruesink, Place 6 'ty of College Station Elected Officials College Station City Council ❑ Ben White, Place 1 ❑ Lynn Mcllhaney, Place 4 NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of Colle. a Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Eric Miller ❑ Lois Koontz ❑ Sarah Adams, Chair ❑ James Batenhorst O David Chester B/CS Library Committee ❑ Katherine Edwards ❑ Don Scherr ❑ Jeanne Mitchell ❑ Jo Berg ❑ James Bradford ft NONE Cemetery Committee O Virginia Reese O Mary Lind Bryan [;it NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Kevin Myers ❑ Joe Wallace ❑ Dan B. Sears, Chairman ❑ George McLean, Vice Chair ❑ Frank Cox ❑ Mike Lane ❑ Larry D. Patton ❑ David Hart, alternate ❑ Steve Parker, alternate ❑ David Ruesink, alternate IVNONE ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev NONE Facade Improvement Program Advisory Committee ❑ Valerian Miranda, Architect 0 Rick Lemmons, Business Owner ❑ Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice GNONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair El Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen PONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. El Mary Sherwood ❑ Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer KNONE Zoning Board of Adjustments ❑ Joshua Berm ❑ John Richards ❑ Donald Braune ❑ Charles Taylor ❑ Derek Dictson ONE O David Hickson ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard Research Valley Partnership Board of Directors ❑ Larry Mariott IIONE Wolf Pen Creek TIF Board 0 Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair 0 Marc Chaloupka O James Massey NONE The following individuals are appointed by the City Council to represent the City of College Station on joint committees with other governmental agencies and community groups. ❑ Susan Lancaster ❑ Ron Silvia, Mayor O Ron Silvia, Mayor ❑ Susan Lancaster O Ron Silvia, Mayor Brazos County Health Department O Nancy Berry fr6NONE Brazos Valley Council of Governments Board of Directors NONE B/CS Metropolitan Planning Organization CPIONE BVCOG TMPA Regional Park Project Advisory Board fialONE BVSWMA Policy Advisory Board ❑ Susan Lancaster NONE ❑ Ron Silvia NONE ❑ Nancy Berry )6 NONE ❑ Nancy Berry NONE ❑ Ron Gay ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee O Ben White 0 John Happ Joint City/School Intergovernmental Committee O Ben White ❑ John Happ Sister Cities Association KNONE Transportation Committee O John Happ ❑ Dennis Christianson, TTI pONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Wolf Pen Creek Oversight Committee El Ron Gay ❑ Chris Scotti NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or other relationship. Attach additional pages to this Form CIQ as necessary. 5. Name of local government officer with whom filer has affiliation or business relationship. (Complete this section only if the answer to A, B, or C is YES. A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? Yes No B. Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local government officer named in this section AND the taxable income is not from the local governmental entity? Yes No C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer or director, or holds an ownership of 10 percent or more? Yes No D. Describe each affiliation or business relationship. 6. 0/1 Signature of person doing business with the governmental entity Date Adopted 01/13/06