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Mecham, D.L.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 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. u,„ -L-- Check this box if you are filing an update to a previously filed questionnaire. 2. (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 Nugenl:, Public Relations • ■ Glenn Brown, City Manager Don Faz7ino, 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 NONE • ■ 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 Facade Improvement Program Advisory Committee College Station City Council B/CS Library Committee Ron Silvia, Mayor Larry Ringer, Chairman • Rick Lemmons, Business Owner John Happ, Place 2 • ■ Ben White, Place 1 • ■ Ron Gay, Place 3 .: NONE Eric Miller Chris Scotti, Place 5 • • Susan Lancaster, Place 4 • • Nancy Berry, Place 6 g<VONE S • City of College Station Committees, Boards, and Commissions Facade Improvement Program Advisory Committee Cemetery Committee B/CS Library Committee Sarah Adams, Chair Larry Ringer, Chairman • Rick Lemmons, Business Owner Katherine Edwards • Don Scherr ■ ■ ■ .: NONE Eric Miller Joe Wallace Jeanne Mitchell ■ Mary Lind Bryan Joh�Berg • • • S Lois Koontz • James Bradford C�YNONE • • Facade Improvement Program Advisory Committee Cemetery Committee Sarah Adams, Chair ■ Valerian Miranda, Architect • Rick Lemmons, Business Owner Kevin Myers • U Virginia Reese ■ ■ Robert Mosley, City Engineer James Batenhorst .: NONE Joe Wallace • ■ Mary Lind Bryan ■ David Chester 4NONE S LONE • Facade Improvement Program Advisory Committee Construction Board of Adjustments and Appeals/Building & Standards Commission Dan B. Sears, Chairman ■ Valerian Miranda, Architect • Rick Lemmons, Business Owner Frank Cox • ■ George McLean, Vice Chair ■ ■ Robert Mosley, City Engineer Mike Lane .: NONE David Hart, alternate • • Larry D. Patton ■ Steve Parket, alternate S LONE • • David Ruesink, alternate Facade Improvement Program Advisory Committee ■ Karen Kasper, Merchant ■ Valerian Miranda, Architect • Rick Lemmons, Business Owner ■ Joey Dunn, Dir. Planning & Dev ■ Robert Mosley, City Engineer ■ Eric Barton, CD Coordinator .: NONE Historic Preservation Committee Joint Relief Funding Review Committee Hillary Jessup, Chairman Rebecca Eplen Bill Lancaster J. Kevin Byrne Marsha Crenwelge ■ ■ ■ ■ Marguerite Anthony Ru leen Maurice David Ruesink Charlotte Mikulee Dipankar Seri • ■ ■ ■ Thomas Taylor NONE Ernie Wright Harry Green Neal Nutall, Jr. • • ■ • Colleen Risinger 6KONE • Planning and Zoning Commission Joint Relief Funding Review Committee Scott Shafer, Chairman Rebecca Eplen Joshua Benn J. Kevin Byrne • Mary Sherwood ■ • ■ Graham Sheffy Ru leen Maurice Bill Davis Charlotte Mikulee Christiansen Peggy Samson • ■ ■ 0 NONE • Harry Green ONE Gary Erwin Planning and Zoning Commission Parks and Recreation Board Scott Shafer, Chairman Kathleen Ireland Joshua Benn Glenn Schroeder • Jodi Warner • ■ ■ Graham Sheffy Carol Blaschke Bill Davis Jeannie McCandless Christiansen Gary Thomas • ■ • Denise Whisenant John Crompton • Harry Green ONE Gary Erwin • • • 0 ONE Planning and Zoning Commission Design Review Board Scott Shafer, Chairman Rick Heany Joshua Benn Ken Reynolds • • John Nichols ■ ■ Marsha Sanford■Dennis Graham Sheffy Alan King Bill Davis • Christiansen ■ • Harold Strong 1gr'NONE Denise Whisenant Susie Cox, alternate • Zoning Board of Adjustments Design Review Board Jay Goss, Chair Rick Heany Joshua Benn Hunter Goodwin John Richards Nancy Sawtelle • ■ • Graham Sheffy Alan King Donald Braune Ward Wells Char es Tayllor Scott Shafer • ■ ■ Denise Whisenant Susie Cox, alternate Derek Dictson Robert Rayburn, alternate ONE ONE • ■ Zoning Board of Adjustments Jay Goss, Chair Joshua Benn John Richards • • ■ Graham Sheffy Donald Braune Char es Tayllor • ■ ■ Denise Whisenant Derek Dictson ONE • ■ Research Valley Partnership Board of Directors Wolf Pen Creek TIF Board Lar Mariott • David Hickson ■ Chris Scotti, Councilman • Glenn Brown, City Manager _■ U 'NONE • Wolf Pen Creek TIF Board Sharon Colson, Chair Marsha Sanford, Vice Chair • ■ ■ Marc//Chaloupka Kenny Mallard James Massey I140NE IN • 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. //.ft/ce. Signature of person doing business with the governmental entity Date Adopted 11/02/2005