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Guaranteed Painting Co.CONFLICT OF INTEREST QUESTIONNAIRE 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, Loca Government Code. An offense under this section is a Class C misdemeanc FORM CIQ OFFICE USE ONLY Date Received 1. Name of person doing business with local governmental entity. c, 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 ❑ Cheryl Turney, Purchasing Mgr. • Harvey Cargill, City Attorney ■ JeffJe/Kersten, Finance 1►W1 ONE • John Woody, Utilities 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 College Station City Council ❑ Ron Silvia, Mayor ❑ Katherine Edwards ❑ Rick Lemmons, Business Owner ■ Ben White, Place 1 • John Happ, Place 2 ❑ Ron Gay, Place 3 ❑ Eric Barton, CD Coordinator ■ Susan Lancaster, Place 4 ■ Chris Scotti, Place 5 ■ Jeanne Mitchell LWNONE ■ Nancy Berry, Place 6 City of College Station Committees, Boards, and Commissions ❑ Sarah Adams, Chair Cemetery Committee ❑ Virginia Reese ❑ Kevin Myers ❑ James Batenhorst ❑ David Chester ❑ Mary Lind Bryan CANON E ❑ Joe Wallace Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Dan B. Sears, Chairman ❑ George McLean, Vice Chair ❑ Frank Cox ❑ Mike Lane ❑ Steve Parker, alternate ❑ Larry D. Patton ❑ David Hart, alternate ❑ David Ruesink, alternate i� iONE B/CS Library Committee ❑ Katherine Edwards ❑ Rick Lemmons, Business Owner • Larry Ringer, Chairman ■ Don Scherr ❑Joey Dunn, Dir. Planning & Dev ❑ Eric Barton, CD Coordinator Jo Berg • Eric Miller ■ Jeanne Mitchell ❑ Lois Koontz —❑ l�'NONE ■ James Bradford ❑ Sarah Adams, Chair Cemetery Committee ❑ Virginia Reese ❑ Kevin Myers ❑ James Batenhorst ❑ David Chester ❑ Mary Lind Bryan CANON E ❑ Joe Wallace Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Dan B. Sears, Chairman ❑ George McLean, Vice Chair ❑ Frank Cox ❑ Mike Lane ❑ Steve Parker, alternate ❑ Larry D. Patton ❑ David Hart, alternate ❑ David Ruesink, alternate i� iONE Facade Improvement Program Advisory Committee ❑ Rick Lemmons, Business Owner • Karen Kasper, Merchant • Valerian Miranda, Architect ❑Joey Dunn, Dir. Planning & Dev ❑ Eric Barton, CD Coordinator ■ Robert Mosley, City Engineer La',NONE Joint Relief Funding Review Committee Historic Preservation Committee • Rebecca Eplen 1 ■ J. Kevin Byrne • Mary Sherwood Hillary Jessup, Chairman ■ Charlotte Mikulee Bill Lancaster E NONE Marsha Crenwelge ■ • • Parks and Recreation Board Marguerite Anthony ❑ Kathleen Ireland David Ruesink ■ Jodi Warner Dipankar Sen • • ■ • Harry Green Thomas Taylor lRONE Ernie Wright Neal Nutall, Jr. • ■ • ❑ Scott Shafer, Chairman Colleen Risinger CLONE • Marsha Sanford • Dennis Christiansen ■ Bill Davis • Joint Relief Funding Review Committee • Rebecca Eplen 1 ■ J. Kevin Byrne • Mary Sherwood • Rusleen Maurice ■ Charlotte Mikulee ■ Peggy Samson E NONE _ Parks and Recreation Board ❑ Kathleen Ireland • Glenn Schroeder ■ Jodi Warner 0 Carol Blaschke • Jeannie McCandless ■ Gary Thomas • JohnJo/Crompton • Harry Green ■ Gary Erwin lRONE Planning and Zoning Commission ❑ Scott Shafer, Chairman • John Nichols • Ken Reynolds • Marsha Sanford • Dennis Christiansen ■ Bill Davis ■ Harold Strong iRNONE Design Review Board ❑ Rick Heany ■ Hunter Goodwin _ ■ Nancy Sawtelle • Alan King ■ Ward Wells ■ Scott Shafer ■ Susie Cox, alternate • Robert Rayburn, alternate E3-NOE Wolf Pen Creek TIF Board ❑ Sharon Colson, Chair O Kenny Mallard O Marsha Sanford, Vice Chair O James Massey 0 Marc Chaloupka Research Valley Partnership Board of Directors Zoning Board of Adjustments Jay Goss, Chair • Joshua Benn ■ • ■ ■ John Richards Graham Sheffy • Donald Braune • ■ ■ Charles Taylor Denise Whisenant Derek Dictson GJ -NONE • ■ Wolf Pen Creek TIF Board ❑ Sharon Colson, Chair O Kenny Mallard O Marsha Sanford, Vice Chair O James Massey 0 Marc Chaloupka Research Valley Partnership Board of Directors David Hickson Chris Scotti, Councilman • Larry Mariott ■ Glenn Brown, City Manager ��■ M 'NONE • Wolf Pen Creek TIF Board ❑ Sharon Colson, Chair O Kenny Mallard O Marsha Sanford, Vice Chair O James Massey 0 Marc Chaloupka 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. Ati-e. mo ce,k-to-6. sCokw.1-\\ A -r � • o& • Q -,r eQ 6. //n6 Si'urserson doing business with the governmental entity Date Adopted 11/02/2005 EXHIBIT A (Service Contract)