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Home My WebLink AboutInkSell.Com02107/2006 11:09 2107980094 INKSELL; ACECOM PAGE 02 CONFLICT OF INTEREST QUESTIONNAIRE 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 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 1.76.006, Local Government Code. An offense under this section is a Class C misdemeanor. OFFICE USE ONLY Date Received 02-07-06A11:00 r, I. Name of person doing business with local governmental entity. 13 rl A -n . ch 13cee,ori,...,,,..,,. — SA / it kge,2. 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 O John Woody, Utilities CI Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev ❑ Don Fazzino, Legislative Liason El Kim Foutz, Economic Dev El Connie Hooks, City Secretary El Jeff Kersten, Finance I/ NONE ❑ Charles McLemore, Public Works El Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge in Cheryl Turney, Purchasing Mgr. Describe each affiliation or business relationship with an employee checked in Question 3 above: 02/0712006 11:09 2107980094 INKSELL; ACECOM PAGE 03 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 El Ben White, Place 1 ❑ Ron Gay, Place 3 ❑ Susan Lancaster, Place 4 ❑ Nancy Berry, Place 6 6%rNONE D 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 ❑ Don Scherr (] Eric Miller ❑ Jeanne Mitchell ❑ .lo Berg ❑ Lois Koontz El James Bradford ONE Cemetery Committee E l Sarah Adams, Chair 0 Virginia Reese ❑ James Batenhorst❑ Niary Lind Bryan ❑ David Chester L9'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 El David Hart, alternate ❑ Steve Parker, alternate ❑ David Ruesink, alternate is NONE ❑ Karen Kasper, Merchant ❑ JO y Dunn, Dir. Planning & Dev NONE Facade Improvement Program Advisory Committee ❑ Valerian Miranda, Architect ❑ Rick Lemmons, Business Owner 0 Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator 02/07/2006 11:09 2107980094 ❑ Hillary Jessup, Chairman O Marguerite Anthony ❑ Thomas Taylor O Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice NONE ❑ Kathleen Ireland ❑ Carol Blaschke .1 NE/NONE❑ hn Crompton • Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Hearty ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy O Denise Whisenant INKSELL; ACECOM Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright NONE Joint Relief Funding Review Committee O J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board O Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission O John Nichols ❑ DD - nnis Christiansen LP/NONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune O Derek Dictson. ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood ❑ 'Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer NI1GON E ❑ John Richards ❑ Charles Taylor 1d' NONE PAGE 04 02/07/2006 11:09 2107980094 ❑ David Hickson ❑ Glenn Brown, City Manager INKSELL; ACECOM PAGE 05 Research Valley Partnership Board of Directors ❑ Larry Marion -1: NONE Wolf Pen Creek TIF Board ❑ Chris Scotti, Councilman ❑ Sharon Colson, Chair ❑ Marsha Sanford, Vice Chair D Marc Chaloupka ❑ Kenny Mallard ❑ James Massey 3/10NE 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 NONE Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayor NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor NONE BVCOG TMPA Regional Park. Project Advisory Board ❑ Susan Lancaster i=1 NONE BVSWMA Policy Advisory Board ❑ Ron Silvia, Mayor 0 Susan Lancaster ®'NONE 02/07/2006 11:09 2107980094 �❑ on Silvia ®NONE ❑>any Berry NONE ❑/Nancy Berry ECJ NONE ❑ Ron Gay INKSELL; ACECOM PAGE 06 City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee ❑ Ben White ❑ John Happ Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association L9'NONE Transportation Committee ❑ Ron Gay ❑ John Happ ❑ Linda LaSuit, MPO El Dennis Christianson, TTI ❑ Bryan Woods, TxDOT NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG El Ron Gay Wolf Pen Creek Oversight Committee ❑ Chris Scotti Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01 /13/06 02/07/2006 11:09 2107980094 INKSELL; ACECOM PAGE 07 CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This section, item 5 including subparts A, 8, 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. Signature of person doig business with the governmental entity Date Adopted 01/13/06