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HomeMy WebLinkAboutDXI Industries, Inc.CONFLICT OF INEREST 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 t require the statement to be filed. See Section 176.006, Local Governmt Code. A person committs an offfnse 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. 2. x .Lndu, -1-2i e s, Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you fille 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 governmental entity who pmakes recommendations to a local government officer of t. entity with respect to expenditure of money. ❑ Robert Alley, Fire Chief ❑ Steve Beachy, Parks & kec ❑ Glenn Brown, City Manger ❑ Olivia Burnside, Inf. Te th. ❑ Pete Caler, Landfill Mg>a. El Harvey Cargill, City Attorney ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev El Don Fazzino, Legislative Liason ❑ Kim Foutz, Economic Dev O Connie Hooks, City Secretary ❑ Jeff Kersten, Finance X NONE of the local �e local governmental O Charles McLemore, Public Works ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Public Works El Ed Spillane, Municipal Judge O Cheryl Turney, Purchasing Mgr. Describe each affiliation or iusiness relationship with an employee checked in Question 3 above: NoA C. 4. Describe each affilia ion or business relationship with a person who is a local g vernment officer and who appoints or emplo s 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 0 John HaPp, Place 2 ❑ Ron Gay, Place 3 0 Susan Lancaster, Place 4 0 Chris Sdotti, Place 5 ❑ Nancy Berry, Place 6 NONE City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman ❑ Eric Miller O Lois Koontz B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell D James Bradford Cemetery Committee ❑ Sarah Adams, Chair ❑ Virginia Reese ❑ James Batenhorst 0 Mary Lind Bryan ❑ David Chester NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Don Schprr ❑ Jo Berg NONE ❑ Kevin M,ers ❑ Joe Wallace ❑ Dan B. Sears, Chairman 0 George McLean, Vice Chair ❑ Frank Coif O Mike Lane El Larry D. Patton 0 David Hail, alternate ❑ Steve Parker, alternate ❑ David Ruesink, alternate J;4 NONE ❑ Karen Kasper, Merchant] ❑ Joey Dunn, Dir. Planning 18z. Dev NONE Facade Improvement Program Advisory Committee El Valerian Miranda, Architect ❑ Robert Mosley, City Engineer ❑ Rick Leminons, Business Owner ❑ Eric Bartoi, CD Coordinator ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice ,.1K NONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King 0 Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink O Ernie Wright NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen NONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments O Joshua Benn ❑ Donald Braune O Derek Dictson ❑ Marsha ❑ Dipank ❑ Neal N Crenwelge r Sen tall, Jr. ❑ Mary S s -rwood ❑ Peggy S : son ❑ Jodi Wa er ❑ Gary Th i, mas ❑ Gary E in ❑ Ken Re olds 0 Bill Davi O Nancy Sa elle ❑ Scott Sha er NONE ❑ John Rich rds ❑ Charles T. ylor g NONE ❑ David Hickson O Glenn Brown, City M ❑ Sharon Colson, Chair ❑ Kenny Mallard The following individua joint committees with of ❑ Susan Lancaster ❑ Ron Silvia, Mayor ❑ Ron Silvia, Mayor 0 Susan Lancaster ❑ Ron Silvia, Mayor Research Valley Partnership Board of Directors El Larry Mariott nager X NONE Wolf Pen Creek TIF Board 0 Chris S•otti, Councilman ❑ Marsha Sanford, Vice Chair 0 Marc C aloupka ❑ James Massey NONE are appointed by the City Council to represent the City of College Station on er governmental agencies and community groups. Brazos County Health Department ❑ Nancy Berry g NONE Brazos Valley Council of Governments Board of Directors NONE B/CS Metropolitan Planning Organization NONE BVCOG TMPA Regional Park Project Advisory Board NONE BVSWMA Policy Advisory Board 0 Susan Lancaster NONE ❑ Ron Silvia X.NONE ❑ Nancy Berry NONE ❑ Nancy Berry X NONE O Ron Gay ❑ Ron Gay ❑ Linda LaSuit, MPO O Bryan Woods, TxDOT City Center Committee O Ben White 0 Nancy berry Intergovernmental Committee ❑ Ben White Joint City/School Intergovernmental Committee ❑ John Happ O Ben White 0 John Ha Sister Cities Association NONE Transportation Committee O John Happ O Dennis Christianson, TTI NONE p ❑ Ken Fogy ❑ Michael Darker, BVCOG Wolf Pen Creek Oversight Committee O Ron Gay O Chris Scotti X NONE Describe each affiliation or OA 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 inclu ing subparts A, B, C & D, must be completed for each office with whom the filer has affiliation or other rel: tionship. Attach additional pages to this Form CIQ as necess. ry. 5. Name of local governent officer with whom filer has affiliation or business rel this section only if the a 4swer to A, B, or C is YES. A. Is the local govenunen officer named in this section receiving or likely to receive to filer of the questionnaire? Ye No B. Is the filer of the questirnnaire receiving or likely to receive taxable income from or local government officer named in this section AND the taxable income is not from the entity? Yes No tionship. (Complete able income from the the direction of the 1 . cal governmental C. Is the filer of this questi nnaire affiliated with a corporation or other business entity at the local government officer serves s an officer or director, or holds an ownership of 10 percent e r more? Yes No D. Describe each affiliation or business relationship. /v0✓) R.C. Karm President, DXI Industries, Inc. October 9, 2006 Signature of person doing business with the governmental entity bate Adopted 01/13/06