American Cooling Tower, Inc.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.
A Meri cin C c° tin JD , �.n� .?,0
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 fill
September 1 of the year for which an activity described in Section 176.006(a), Local Gover
not later than the 7th business day after the date the originally filed questionnaire becomes
ng authority not later than
nment Code, is pending and
ncomplete 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
❑ Steve Beachy, Parks & Rec
❑ Glenn Brown, City Manager
❑ Olivia Burnside, inf. Tech.
❑ Pete Caler, Landfill Mgr.
❑ Harvey Cargill, City Attorney
❑ John Woody, Utilities
❑ Michael Clancey, Police Chief
❑ Joey Dunn, Planning & Dev
❑ Don Fazzino, Legislative Liason
❑ Charles Wood, Economic Dev
El Connie Hooks, City Secretary
❑ Jeff Kersten, Finance
NONE
❑ Cha
❑ Bed
❑ Julie
❑ Mar
❑ Ed
❑ Che]
les McLemore, Public Works
y Nugent, Public Relations
O'Connell, Human Resources
Smith, Public Works
pillane, Municipal Judge
yl Turney, Purchasing Mgr.
Describe each affiliation or business relationship with an employee checked in Ques
ion 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
❑ Nancy Berry, Place 6
City of College Station Elected Officials
College Station City Council
❑ Ben White, Place I
O Susan Lancaster, Place 4
NONE
❑ John Happ, Place 2
❑ ChI•is Scotti, Place 5
City of College Station Committees, Boards, and Commissions
❑ Larry Ringer, Chairman
❑ Eric Miller
❑ Lois Koontz
❑ Sarah Adams, Chair
❑ James Batenhorst
❑ David Chester
❑ Dan B. Sears, Chairman
❑ Mike Lane
❑ Steve Parker, alternate
❑ Karen Kasper, Merchant
❑ Joey Dunn, Dir. Planning & Dev
NONE
B/CS Library Committee
❑ Katherine Edwards 0 Doti Scherr
❑ Jeanne Mitchell 0 Jo lerg
❑ James Bradford V NONE
Cemetery Committee
❑ Virginia Reese
❑ Mary Lind Bryan
*NONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
❑ George McLean, Vice Chair
❑ Larry D. Patton
❑ David Ruesink, alternate
Facade Improvement Program
Advisory Committee
❑ Valerian Miranda, Architect
O Robert Mosley, City Engineer
❑ Kevin Myers
❑ Joe Wallace
❑ Fr Cox
❑ Dav d Hart, alternate
NONE
O Rick
Lemmons, Business Owner
O Eric Barton, CD Coordinator
❑ Hillary Jessup, Chairman
❑ Marguerite Anthony
❑ Thomas Taylor
❑ Colleen Risinger
❑ Rebecca Eplen
❑ Rusleen Maurice
NONE
❑ Kathleen Ireland
O Carol Blaschke
❑ John Crompton
113- NONE
❑ Scott Shafer, Chairman
❑ Marsha Sanford
❑ Harold Strong
❑ Rick Heany
O Alan King
❑ Susie Cox, alternate
❑ Jay Goss, Chair
❑ Graham Sheffy
❑ Denise Whisenant
Historic Preservation Committee
❑ Bill Lancaster
❑ David Ruesink
❑ Ernie Wright
NONE
Joint Relief Funding Review
Committee
❑ J. Kevin Byrne
❑ Charlotte Mikulee
Parks and Recreation Board
❑ Glenn Schroeder
❑ Jeannie McCandless
❑ Harry Green
Planning and Zoning
Commission
❑ John Nichols
❑ Dennis Christiansen
j NONE
Design Review Board
O Hunter Goodwin
❑ Ward Wells
O Robert Rayburn, alternate
Zoning Board of Adjustments
❑ Joshua Benn
❑ Donald Braune
❑ Derek Dictson
❑ Malrsha Crenwelge
❑ Di ankar Sen
❑ Ne 1 Nutall, Jr.
O Maiy Sherwood
O Peggy Samson
❑ Jodl Warner
❑ Gary Thomas
❑ Ga ry Erwin
O Ken Reynolds
O Bill avis
❑ Nano), Sawtelle
❑ Scot Shafer
.NONE
❑ John Richards
❑ Charles Taylor
NON
O David Hickson
O Glenn Brown, City Manager
❑ Sharon Colson, Chair
❑ Kenny Mallard
Research Valley Partnership
Board of Directors
❑ Larry Marion
NONE
Wolf Pen Creek TIF Board
❑ Ch
is Scotti, Councilman
O Marsha Sanford, Vice Chair ❑ Ma -c Chaloupka
O James Massey 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.
❑ Susan Lancaster
❑ Ron Silvia, Mayor
❑ Ron Silvia, Mayor
❑ Susan Lancaster
❑ Ron Silvia, Mayor
Brazos County Health
Department
❑ Nancy Berry Xi NONE
Brazos Valley Council of
Governments Board of Directors
NONE
B/CS Metropolitan Planning
Organization
`INONE
BVCOG TMPA Regional Park
Project Advisory Board
y NONE
BVSWMA Policy Advisory
Board
O Susan Lancaster NONE
❑ Ron Silvia
NONE
Q Nancy Berry
-434 NONE
❑ Nancy Berry
NONE
City Center Committee
O Ben White 0 Nahcy Berry
Intergovernmental Committee
O Ben White ❑ Jo Happ
Joint City/School
Intergovernmental Committee
O Ben White 0 Joh Happ
Sister Cities Association
O Ron Gay ,f1 NONE
O Ron Gay
O Linda LaSuit, MPO
O Bryan Woods, TxDOT
Transportation Committee
O John Happ
❑ Dennis Christianson, TTI
NONE
❑ Ken Fogle
❑ Miciael Parker, BVCOG
Adopted 01/13/06
Wolf Pen Creek Oversight
Committee
III NONE
■ Ron Gay
■ Chris Scotti
Describe each affiliation or business relationship with an employee checked in Question
4 above:
Adopted 01/13/06
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with local governmental entity
FORM CIQ
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 busines 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 receiie taxable income from the
filer of the questionnaire?
Yes
No
B. Is the filer of the questionnaire receiving or likely to receive taxable income froth 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
C�7
No
C. Is the filer of this questionnaire affiliated with a corporation or other business en ity that the local
government officer serves as an officer or director, or holds an ownership of 10 per ent or more?
Yes
No
D. Describe each affiliation or business relationship.
6.
Signature of person doing business with the governmental entity
Date
Adopted 01/13/06