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HomeMy WebLinkAboutJalco, Inc.CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ 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 filed with the records administrator of the local government not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code. A person committs an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. OFFICE USE ONLY Date Received 1. Name of person doing business with local governmental entity. c -c, V'Nc_. _ 2. 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 activity 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 business 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 ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev El Don Faz7ino, Legislative Liason D Charles Wood, Economic Dev ❑ Connie Hooks, City Secretary O Jeff Kersten, Finance 'NONE ❑ Charles McLemore, Public Works E l Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources El Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge O Cheryl Turney, Purchasing Mgr. Describe each affiliation or business relationship with an employee checked in Question 3 above: 4. Describe each affiliation or business relationship with a person who is a local government officer and who appoints or employs a local government officer of the local government entity that is the subject of this questionnaire. City of College Station Elected Officials College Station City Council ❑ Ron Silvia, Mayor ❑ Ben White, Place 1 ❑ Ron Gay, Place 3 0 Susan Lancaster, Place 4 ❑ Nancy Berry, Place 6 R NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ Larry Ringer, Chairman ❑ Katherine Edwards 0 Don Scherr ❑ Eric Miller ❑ Jeanne Mitchell ❑ Jo Berg ❑ Lois Koontz 0 James Bradford F, NONE ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Dan B. Sears, Chairman O Mike Lane ❑ Steve Parker, alternate ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev la NONE Cemetery Committee ❑ Virginia Reese ❑ Mary Lind Bryan p NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ George McLean, Vice Chair ❑ Larry D. Patton ❑ David Ruesink, alternate Facade Improvement Program Advisory Committee ❑ Kevin Myers ❑ Joe Wallace ❑ Frank Cox ❑ David Hart, alternate lel NONE ❑ 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 lk NONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton F NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright N 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 El Dennis Christiansen . NONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood ❑ Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds O Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer ( `NONE Zoning Board of Adjustments ❑ Joshua Benn 0 John Richards ❑ Donald Braune ❑ Charles Taylor ❑ Derek Dictson '„NONE ❑ David Hickson ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair O Kenny Mallard Research Valley Partnership Board of Directors ❑ Larry Mariott NONE Wolf Pen Creek TIF Board ❑ Marsha Sanford, Vice Chair O James Massey 0 Chris Scotti, Councilman ❑ Marc Chaloupka 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. Brazos County Health Department ❑ Susan Lancaster ❑ Nancy Berry 94, NONE Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayor EA NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor NONE BVCOG TMPA Regional Park Project Advisory Board 0 Susan Lancaster l�, NONE BVSWMA Policy Advisory Board 0 Ron Silvia, Mayor 0 Susan Lancaster NONE ❑ Ron Silvia pfk NONE ❑ Nancy Berry NONE ❑ Nancy Berry 1S,NONE City Center Committee 0 Ben White ❑ Nancy Berry Intergovernmental Committee 0 Ben White 0 John Happ Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Ron Gay NONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee O John Happ O Dennis Christianson, TTI NONE Wolf Pen Creek Oversight Committee ❑ Ken Fogle ❑ Michael Parker, BVCOG 0 Ron Gay 0 Chris Scotti 14 NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ 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. Signature of person doing business with the governmental entity Date Adopted 01/13/06