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Acecom, Inc. Sa / Inksell.com02/07/2006 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 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. I . Name of person doing business with local governmental entity. 2. OFFICE USE ONLY Date Received - SA / IrkSRle. 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 O Steve Beachy, Parks & Rec ❑ Glenn Brown, City Manager ❑ Olivia Burnside, Inf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney El John Woody, Utilities L Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev ❑ Don Fazzino, Legislative Liason ❑ Kim Foutz, Economic Dev ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Finance NONE El Charles McLemore, Public Works ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, 1-luman Resources ❑ Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney„ Purchasing Mgr. Describe each affiliation or business relationship with an employee checked in Question 3 above: 02/07/2006 11:09 2107980094 INKSELL; ACECON1 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 ❑ Ben White, Place 1 ❑ Ron Gay, Place 3 ❑ Susan Lancaster, Place 4 ❑ Nancy Berry., Place 6 L�NONE ❑ John Happ, Place 2 LI 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 ❑ Jo Berg ❑ Lois Koontz ❑ James Bradford t'NONE Cemetery Committee ❑ Sarah Adams. Chair ❑ Virginia Reese ❑ James Batenhorst N:pry Lind Bryan ❑ David ChesterL NONE ❑ Dan B. Sears. Chairman. ❑ Mike Lane ❑ Steve Parker, alternate ❑ Karen Kasper., Merchant ❑ .Toy Dunn, Dir. Planning & Dev P*AONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Kevin Myers © Joe Wallace ❑ George McLean, Vice Chair ❑ Frank Cox ❑ Larry D. Patton ❑ David Hart, alternate ❑ David Ruesink, alternate NONE Facade Improvement Program Advisory Committee ❑ Valerian Miranda, Architect ❑ Rick Lernmons„ Business Owner ❑ Robert Mosley, City Engineer ❑ Eric Barton, CL) Coordinator 02/07/2006 11:09 2107980094 ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusieen Maurice NONE ❑ Kathleen Ireland ❑ Carol Blaschke El John Crompton NONE • Scott Shafer, Chairman ❑ Marsha Sanford El Harold Strong ❑ Rick Heany El Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant INKSELL; ACECOM Historic Preservation Committee El Bill Lancaster ❑ David Ruesink Cl Ernie Wright NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne El Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder Cl Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ John Nichols ❑ D nnis Christiansen er NONE Design Review Board ❑ Hunter Goodwin El Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn El Donald Braune Cl Derek Dictson ❑ Marsha Crenvvelge El Dipankar Sen El Neal Nutal 1, J r. ❑ Mary Sherwood ❑ Peggy Samson C� Jodi Warner ❑ Gary Thomas El Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer LI, ONE ❑ John Richards ❑ Charles Taylor Vd` NONE PAGE 04 02107/2006 11:09 2107980094 E David Hickson ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard INKSELL; ACECOM PAGE 05 Research Valley Partnership Board of Directors ❑ Larry Marion -L NONE Wolf Pen Creek TIF Board ❑ Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair LI Marc Chaloupka ❑ James Massey E/NONE 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 D Susan Lancaster ❑ Nancy Berry NONE Brazos Valley Council of Governments Board of Directors in Ron Silvia, Mayor NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor ' NONE BVCOG TMPA Regional Park Project Advisory Board ❑ Susan Lancaster /NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Susan Lancaster 614 -NE 02/07/2006 11:09 2107980094 CI,Roti Silvia NONE LI yancy Berry KNONE O Nancy Berry NONE O Ron Gay LI Ron Gay O Linda LaSuit, MPO O Bryan Woods, Txl)OT I NKSELL ; ACECOM PAGE 06 City Center Committee 0 Ben White 0 Nancy Berry Intergovernmental Committee El Ben White 17 John Happ Joint City/School Intergovernmental Committee CI Ben White CI John Rapp Sister Cities Association '1540NE Transportation Committee 0 John Happ 0 Dennis Christianson, TT1 NONE O Ken Fogle O Michael Parker, BVCOG Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01 /13/06 Wolf Pen Creek Oversight Committee 0 Ron Gay Li Chris Scotti k"ONE 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,..,.T,...._......,........_....._..._,_._ __ 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, R, 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? LJ Yes 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 Trio 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? LI Yes No D. Describe each affiliation or business relationship. 6. Signature of person doilig business with the governmental entity Date Adopted 01/13/06