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Texas Power ConstructionCONFLICT 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. OFFICE USE ONLY Date Received 1. Name of person doing business with local governmental entity. 2. 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 O 1 livia Burnside, Inf. Tech. O Pete Caler, Landfill Mgr. ❑ e arvey Cargill, City Attorney E "NINE ❑ Michael Clancey, Police Chief O Lance Simms, Planning & Dev O John Woody, W/WW ❑ Terry Childers, Deputy City Mgr O Connie e ooks, City Secretary ❑ Jeff Kersten, Chief Fin.1 fficer 0 O Becky Nugent, Public Relations O Julie O'&jrinell, Human Resources O Mark Smith, Public Works O Ed Spillane, Municipal Judge O Cheryl Turney, Purchasing Mgr. O David Massey, Electric Describe each affiliation or business relationship with an employee checked inn uestion 3 above: 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. ❑ Ron Silvia, Mayor ❑ Ron Gay, Place 3 ❑ David Ruesink, Place 6 City of College Station Elected Officials College Station City Council ❑ Ben White, Place 1 ❑fLynn McIlhaney, Place 4 EJ NONE O John Happ, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman O Mary Fran Troy O Jennifer Bohac O Sarah Adams, Chair O James Batenhorst O David Chester ❑ Donald Braune ❑ Dan B. Sears, Chairman O Mike Lane O Steve Parker, alternate L"NONE B/CS Library Committee ❑ Katherine Edwards 0 Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Weldon Kruger ❑ RC Slocum Ig -NONE Construction Board of Adjustments and Appeals/Building & Standards Commission O Frank Cox O Larry D. Patton ❑ Glenn Thomas, alternate O Don Scherr O B. Carroll Johnson Q4IONE O Kevin Myers O Joe Wallace ❑ James Matson O David Hart ❑ Charles Thomas, alternate ❑ Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright "NONE ❑ Rebecca Eplen ❑ Rusleen Maurice LI/NONE O Jodi Warner, Chair O Shawn Rhodes O John Crompton ONE Historic Preservation Committee ❑ Bill Lancaster O Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee O J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board ❑ Kathleen Ireland O Jody Ford ❑ Harry Green Planning and Zoning Commission ❑ John Nichols, Chair 0 Glenn Schroeder O Marsha Sanford 0 Dennis Christiansen O Harold Strong 63(NONE Design Review Board ❑ Marguerite Anthony ❑ Meredith Waller ❑ Colleen Risinger ❑ Deborah Deitering O Peggy Samson O Joan Perry O Gary Thomas O Gary Erwin ❑ Derek Dictson El Bill Davis O Rick Heany 0 Hunter Goodwin 0 Nancy Sawtelle O Alan King 0 Ward Wells 0 John Nichols ❑ Susie Cox, alternate 0 Robert Rayburn, alternate 07NONE ❑ Jay Goss, Chair ❑/Denise Whisenant E NONE Zoning Board of Adjustments O Joshua Benn O Donald Braune O John Richards O Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager O Sharon Colson, Chair O Kenny Mallard O Don Lewis O Gregg Baird O Chad Jones ❑ Stephen Syptak, Chair ❑ Tom Kirkland IiNONE ❑ Hugh Lindsay, Area I ❑ John Crompton, Area II ❑ Steve Arden, Area III ❑ Hugh Stearns, Area IV ❑ Andrew Burleson, Student Resident ❑ Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation ❑ Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors ❑ Larry Mariott 1?NONE Wolf Pen Creek TIF Board ❑ Marsha Sanford, Vice Chair ❑ James Massey Outside Agency Funding Review ❑ Charles Taylor ❑ Sheryl Welford 12/NONE Northgate Tax Increment Finance Board ❑ David Scarmardo O Glenn Thomas Comprehensive Plan Committee ❑ John Richards, Area I ❑ Brian Bochner, Area II ❑ Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ Kristina Campbell, Alternate, Student Resident ❑ Craig Hall, ResidentjAtjLarge ❑ Lynn Mcllhaney, Alternate, Councilmember O Gary Erwin, Parks & Rec O Larry Haskins, Northgate District Assoc. O Chris Scotti, Councilman ❑ Marc Chaloupka NONE ❑ Roger Reese ❑ Carolyn Berrow O Anne Jackson O DMO'RILily ❑ David Hart, Alternate, Area I ❑ Dennis Corrington, Acte, Area II ❑ Tom Taylor, Alternate, Area III ❑ Adrian Williams, Alternate, Area N ❑ DRu j (jiRrs4, ETJ RAKiFpW ❑ Mike Guido, Alternate, ResidentjAtjLarge O Bill Davis, P&Z O Kathleen Ireland, Parks & Rec Alternate ❑ Bo Miles, Building & Land Development ❑ Larry Marriott, Home Builders Assoc. ❑ Tedi Ellison, Intergovernmental Comm/Chamber of Commerce ❑ James Massey, Intergovernmental Comm/TAMU Admin O Dr. Clark Ealy, Intergovernmental Comm/CSISD O Chuck Martinez, Intergovernmental Comm/ Research Valley Patnership O Linda LaSut, Intergovernmental Comm/MPO ❑ Lindsey Guindi, Intergovernmental Comm/Chamber of Commerce O Chad Bohne, Intergovernmental Comm/TxDOT O Michael Parks, Intergovernmental Comm/BVCOG O Rodney Weis, Intergovernmental 0 Comm/TAMU Transit O Dr. Colleen Netterville, 0 Intergovernmental Comm/BISD ❑ Margie Lucas, Intergovernmental Comm/ Brazos Transit District Gary Arnold, Intergovernmental Comm/Brazos County Sheriff Gary Teston, Intergovernmental Comm/ Easterwood Airport 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 ❑ Lynn Mcllhaney 0 Ben White NONE Brazos Valley Council of —/ Governments O Ron Silvia, Mayor E NONE B/CS Metropolitan Planning Organization O Ron Silvia, Mayor 'NONE BVCOG TMPA Regional Park Project Advisory Board O Lynn Mcllhaney /NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Chris Scotti IWNIONE City Center Committee ❑ Ron Silvia 0 Ben White 0 Dave Ruesink [NONE ❑ Ron Gay trNONE Intergovernmental Committee 0 Ben White 0 John Happ ❑ Dave Ruesink ff/NONE Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association O Dave Ruesink 1 NONE O Ron Gay O Ken Fogle ❑ Michael Parker, BVCOG O Ron Gay Transportation Committee ❑ John Happ O Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee O Chris Scotti ❑ Lynn Mcllhaney ❑ Dennis Christianson, TTI NONE Er -NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01/13/06 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 govemmental 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. Signa,. f person doing business with the governmental entity Date Adopted 01/13/06 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. OFFICE USE ONLY Date Received 1. Name of person doing business with local governmental entity. 2. eilfr f / I. , erCer,i 5 4-.4-c--4 Cr hC 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 ❑ Michael Clancey, Police Chief ❑ Charles McLemore, Public Works ❑ Steve Beachy, Parks & Rec ❑ Joey Dunn, Planning & Dev ❑ Becky Nugent, Public Relations E Glenn Brown, City Manager E 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 NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: v 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. ❑ Ron Silvia, Mayor ❑ Ron Gay, Place 3 ❑ Nancy Berry, Place 6 City of College Station Elected Officials College Station City Council ❑ Ben White, Place 1 ❑ Susan Lancaster, Place 4 PNONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ Larry Ringer, Chairman 0 Katherine Edwards 0 Don Schen: O Eric Miller 0 Jeanne Mitchell ,❑ Jo Berg 8 O Lois Koontz 0 James Bradford NhONE Cemetery Committee ❑ Sarah Adams, Chair 0 Virginia Reese ❑ James Batenhorst El Mary Lind Bryan ❑ David Chester IIVONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Kevin Myers O Joe Wallace O Dan B. Sears, Chairman 0 George McLean, Vice Chair ❑ Frank Cox O Mike Lane 0 Larry D. Patton ❑David Hart, alternate 1 ❑ Steve Parker, alternate 0 David Ruesink, alternate NONE Facade Improvement Program Advisory Committee O Karen Kasper, Merchant 0 Valerian Miranda, Architect 0 Rick Lemmons, Business Owner O J'y Dunn, Dir. Planning & Dev 0 Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator 2*'NONE ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony O Thomas Taylor O Colleen Risinger O Rebecca Eplen O Rusleen Maurice ONE O Kathleen Ireland O Carol Blaschke O John Crompton ILK -ONE O Scott Shafer, Chairman ❑ Marsha Sanford O Harold Strong O Rick Heany O Alan King O Susie Cox, alternate O Jay Goss, Chair O Graham Sheffy O Denise Whisenant Historic Preservation Committee O Bill Lancaster O David Ruesink O Ernie Wright KONE Joint Relief Funding Review Committee O J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder O Jeannie McCandless O Harry Green Nanning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen 6 NONE Design Review Board ❑ Hunter Goodwin O Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn O Donald Braune ❑ Derek Dictson ❑ Marsha Crenwelge ❑ Dipankar Sen O Neal Nutall, Jr. O Mary Sherwood O Peggy Samson ❑ Jodi Warner ❑ Gary Thomas O Gary Erwin O Ken Reynolds O Bill Davis ❑ Nancy Sawtelle O Scott Shafer ONE O John Richards ❑ Charles Taylor ONE O David Hickson O Glenn Brown, City Manager O Sharon Colson, Chair O Kenny Mallard Research Valley Partnership Board of Directors 0 Larry Mariott NONE Wolf Pen Creek TIF Board 0 Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair �!� 0 Marc Chaloupka ❑ James Massey i2 ONE 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 O Susan Lancaster 0 Nancy Berry E NONE Brazos Valley Council of Governments Board of Directors O Ron Silvia, Mayor &V. -NONE B/CS Metropolitan Planning Organization O Ron Silvia, Mayor &'NONE BVCOG TMPA Regional Park Project Advisory Board O Susan Lancaster NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Susan Lancaster i2'NONE ❑ Ron Silvia 1;e0NE O Nancy Berry E�NONE ❑ Nancy Berry DONE City Center Committee ❑ Ben White 0 Nancy Berry Intergovernmental Committee 0 Ben White 0 John Happ Joint City/School Intergovernmental Committee 0 Ben White 0 John Happ Sister Cities Association O Ron Gay Pr NuNE Transportation Committee ❑ Ron Gay 0 John Happ O Linda LaSuit, MPO 0 Dennis Christianson, TTI O Bryan Woods, TxDOT (?'NONE ❑ Ken Fogle O Michael Parker, BVCOG Wolf Pen Creek Oversight Committee O Ron Gay 0 Chris Scotti SONE Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01113/06 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. of person doing business with the governmental entity Date Adopted 01 /13/06