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Young Contractors, Inc.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. FORM CIQ OFFICE USE ONLY Date Received A person committs an offense if the person violates Section 176.006, Loca0 2 - 01- 0 6 P 0 3 : 23 t< L, Government Code. An offense under this section is a Class C misdemean 1. Name of person doing business with local governmental entity. /Lt. 14e-forn 16(4-05 dwiraxiiarS 2. J 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 0 Michael Clancey, Police Chief ■ Charles McLemore, Public Works 0 Steve Beachy, Parks & Rec 0 Joey Dunn, Planning & Dev ■ Becky Nugent, Public Relations 0 Glenn Brown, City Manager 0 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. 0 Connie Hooks, City Secretary ■ Ed Spillane, Municipal Judge 0 Jeff Kersten, Finance ❑ Cheryl Turney, Purchasing Mgr. is Harvey Cargill, City Attorney 0 John Woody, Utilities g 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 College Station City Council ❑ Ron Silvia, Mayor ❑ Ben White, Place l ❑ John Happ, Place 2 ■ Larry Ringer, Chairman 0 Susan Lancaster, Place 4 ■ Chris Scotti, Place 5 ■ Ron Gay, Place 3 ■ Jeanne Mitchell k3' NONE r James Bradford ■ Nancy Berry, Place 6 City of College Station Committees, Boards, and Commissions B/CS Library Committee 0 Katherine Edwards 0 Don Scherr ■ Larry Ringer, Chairman ❑ Eric Miller 0 Mary Lind Bryan 0 Jo Berg ■ Jeanne Mitchell ❑ Lois Koontz r James Bradford lit NONE Cemetery Committee 0 Virginia Reese 0 Kevin Myers ■ Sarah Adams, Chair ❑ James Batenhorst 0 Mary Lind Bryan 0 Larry D. Patton ■ Joe Wallace ■ Mike Lane 1. NONE 0 David Ruesink, alternate ■ David Chester Construction Board of Adjustments and Appeals/Building & Standards Commission 0 Valerian Miranda, Architect 0 Frank Cox ■ Dan B. Sears, Chairman ■ George McLean, Vice Chair 0 Robert Mosley, City Engineer 0 Larry D. Patton 0 David Hart, alternate ■ Mike Lane 0 David Ruesink, alternate IR NONE ■ Steve Parker, alternate Facade Improvement Program Advisory Committee 0 Valerian Miranda, Architect 0 Rick Lemmons, Business Owner ■ Karen Kasper, Merchant 0 Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator ■ Joey Dunn, Dir. Planning & Dev aNON E Historic Preservation Committee ❑ Hillary Jessup, Chairman ❑ Bill Lancaster 0 Marsha Crenwelge ❑ Marguerite Anthony ❑ Jeannie McCandless 0 Dipankar Sen • David Ruesink ❑ Thomas Taylor 0 Ernie Wright tet NONE • Neal Nutall, Jr. ❑ Colleen Risinger Sit NONE Joint Relief Funding Review Committee O Rebecca Eplen ❑ J. Kevin Byrne ❑ Mary Sherwood O Rusleen Maurice 0 Charlotte Mikulee 0 Peggy Samson i1NONE Parks and Recreation Board O Kathleen Ireland 0 Glenn Schroeder 0 Jodi Warner ■ Scott Shafer, Chairman ❑ Jeannie McCandless ❑ Gary Thomas ■ Carol Blaschke ❑ John Crompton 0 Harry Green tet NONE ■ Gary Erwin ole] NONE • Denise Whisenant Planning and Zoning Commission r ❑ Rick Heany 0 John Nichols ❑ Ken Reynolds ■ Scott Shafer, Chairman 0 Alan King 0 Dennis Christiansen ❑ Bill Davis • Marsha Sanford ❑ Harold Strong tet NONE 10 NONE Design Review Board r ❑ Rick Heany ❑ Hunter Goodwin ❑ John Richards ■ Nancy Sawtelle 0 Alan King ❑ Ward Wells ❑ Charles Taylor ■ Scott Shafer ❑ Susie Cox, alternate ❑ Robert Rayburn, alternate 10 NONE Zoning Board of Adjustments ❑ Joshua Benn ❑ John Richards • Jay Goss, Chair ❑ Donald Braune ❑ Charles Taylor • Graham Sheffy 0 Derek Dictson aNONE • Denise Whisenant Research Valley Partnership Board of Directors 0 Sharon Colson, Chair 0 Larry Mariott ■ David Hickson • Chris Scotti, Councilman 0 Glenn Brown, City Manager lr NONE fii. NONE Wolf Pen Creek TIF Board 0 Sharon Colson, Chair ■ Marsha Sanford, Vice Chair ■ Marc Chaloupka 0 James Massey fii. NONE ■ Kenny Mallard CONFLICT OF INTEREST QUESTIONNAIRE 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 th filer has affiliation or other relationship. Attach additional pages to this Form C1Q as necessary. FORM CI(� 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 NC. 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 a No D. Describe each affiliation or business relationship. 6. At/it - Yestza ai 3 J• r/z/o!� Signature of person doing business with the governmental entity Date Adopted 11/02/2005