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Derby, Diana L.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. 1. Name of person doing business with local governmental entity. ))yank. L. bush/ 2. 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 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. Name each employee or contractor of the local governmental entity who makes recommendations to a local government officer of the governmental entity with respect to expenditures of money AND describe the affiliation or business relationship. Robert Alley, Fire Chief Michael Clancey, Police Chief Charles McLemore, Public Works • ■ • Steve Beachy, Parks & Rec Joey Dunn, Planning & Dev Becky Nugent, Public Relations • ■ ■ Glenn Brown, City Manager Don Fazzino, Legislative Liason Julie O'Connell, Human Resources • ■ ■ Olivia Burnside, Inf. Tech. Kim Foutz, Economic Dev Mark Smith, Public Works ■ • ■ Pete Caler, Landfill Mgr. Connie Hooks, City Secretary Ed Spillane, Municipal Judge • ■ ■ Harvey Cargill, City Attorney Jeff Kersten, Finance Cheryl Turney, Purchasing Mgr. ■ ■ ■ John Woody, Utilities vioNONE • 4. Name each local government officer who appoints or employs local government officers of the governmental entity for which this questionnaire is filed AND describe the affiliation or business relationship. City of College Station Elected Officials City of College Station Committees, Boards, and Commissions Construction Board of Adjustments and Appeals/Building & Standards Commission College Station City Council B/CS Library Committee Ron Silvia, Mayor ■ George McLean, Vice Chair Katherine Edwards John Happ, Place 2 • ■ Ben White, Place 1 • • Larry D. Patton Ron Gay, Place 3 Jeanne Mitchell Chris Scotti, Place 5 • ■ Susan Lancaster, Place 4 ■ Nancy Berry, Place 6 N NONE James Bradford f NONE ■ ■ City of College Station Committees, Boards, and Commissions Construction Board of Adjustments and Appeals/Building & Standards Commission Cemetery Committee B/CS Library Committee Larry Ringer, Chairman ■ George McLean, Vice Chair Katherine Edwards Kevin Myers • • ■ Don Scherr • Larry D. Patton Eric Miller Jeanne Mitchell Joe Wallace ■ ■ ■ Jo Berg Lois Koontz 121 NONE James Bradford f NONE • ■ Construction Board of Adjustments and Appeals/Building & Standards Commission Cemetery Committee Sarah Adams, Chair ■ George McLean, Vice Chair ■ Frank Cox Kevin Myers ■ • Virginia Reese ■ • Larry D. Patton James Batenhorst Joe Wallace • ■ Mary Lind Bryan ■ David Chester 121 NONE ■ Construction Board of Adjustments and Appeals/Building & Standards Commission Facade Improvement Program Advisory Committee • Dan B. Sears, Chairman ■ George McLean, Vice Chair ■ Frank Cox Rick Lemmons, Business Owner ■ ■ Valerian Miranda, Architect • Mike Lane • Larry D. Patton ■ David Hart, alternate ' NONE ■ Steve Parker, alternate ■ David Ruesink, alternate ■ Facade Improvement Program Advisory Committee Karen Kasper, Merchant Rick Lemmons, Business Owner ■ ■ Valerian Miranda, Architect ■ Joey Dunn, Dir. Planning & Dev Eric Barton, CD Coordinator ■ ■ Robert Mosley, City Engineer ■ NONE Historic Preservation Committee Parks and Recreation Board Hillary Jessup, Chairman J. Kevin Byrne Bill Lancaster Mary Sherwood Marsha Crenwelge ■ ■ ■ ■ Marguerite Anthony Carol Blaschke David Ruesink • Rusleen Maurice Dipankar Sen ■ IN ■ ■ Thomas Taylor John Crompton Ernie Wright Harry Green Neal Nutall, Jr. ■ ■ • ■ Colleen Risinger rg NONE ■ Joint Relief Funding Review Committee Parks and Recreation Board Jay Goss, Chair J. Kevin Byrne Joshua Benn Mary Sherwood • Rebecca Eplen ■ ■ ■ ■ Charlotte Mikulee Carol Blaschke Peggy Samson • Rusleen Maurice ■ • (XI NONE • ■ John Crompton Planning and Zoning Commission Parks and Recreation Board Jay Goss, Chair Kathleen Ireland Joshua Benn Glenn Schroeder • Scott Shafer, Chairman Jodi Warner ■ ■ ■ Dennis Christiansen Carol Blaschke Bill Davis Jeannie McCandless ■ Gary Thomas ■ • ■ John Crompton 1,4 NONE Harry Green VI NONE Gary Erwin • ■ ■ '4 NONE Planning and Zoning Commission Design Review Board Jay Goss, Chair John Nichols Joshua Benn Ken Reynolds • Scott Shafer, Chairman • ■ ■ ■ Dennis Christiansen Alan King Bill Davis • Marsha Sanford ■ • ❑ Harold Strong ■ NONE Susie Cox, alternate Design Review Board Jay Goss, Chair Rick Heany Joshua Benn Hunter Goodwin • Nancy Sawtelle ■ ■ ■ Alan King ❑ Charles Taylor Ward Wells • Scott Shafer • ■ ■ Susie Cox, alternate 1,4 NONE Robert Rayburn, alternate VI NONE ■ ■ Zoning Board of Adjustments Jay Goss, Chair Joshua Benn • ■ • John Richards Graham Sheffy Donald Braune ❑ Charles Taylor • • Denise Whisenant Derek Dictson 1,4 NONE ■ • Research Valley Partnership Board of Directors Wolf Pen Creek TIF Board David Hickson Marsha Sanford, Vice Chair Chris Scotti, Councilman • • Larry Mariott • Glenn Brown, City Manager I;gf NONE James Massey xf NONE • ■ Wolf Pen Creek TIF Board Sharon Colson, Chair Marsha Sanford, Vice Chair • • • Marc Chaloupka Kenny Mallard James Massey xf NONE • ■ 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? 1 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? 1 Yes No D. Describe each affiliation or business relationship. 6. 421141_41-- o�. Signature of person doing business with the governmental entity Date Adopted 11/02/2005