Bite Terminator05/ 04/ 2006 16:53 3187472914 SITE TERMINATOR LLC PAGE 02/03
05/04/2006 13:29 FAX 979 764 3791 CCS UTILITIES 4uuz
Joyce Buda - Conflict OigcIoSure St itement - Ven or Cluestionng!irp.pdf Page I
CONFLICT OF INTEREST QUES1iONNAIRE FORM CIO
For vendor or other person doing businese with local governmental entity
►8 filed accordance with aptar 176 of the Loud
This questionnaire la bcltincn
Ootrernment Codo by a parson doing business with the governmental entity.
By law this questfonneire must be Ned with the records Wirninistrattar of the
local government not later then the 7th busineflu day after the dare the person
bccOrnetS aware of facts that require the statement to he filed. See Section
176.0os, Lobel Government Cade.
A person commis an offense if the person *Oates Section 174.000, Local
Code. An (Menne nne under this section ie e Clans C m rnaanor.
ot1FlGVlls601�'Y
cvt. ,:,.e
�, rGovernment
oalgQnentalerdity.
u tameufpareentloinglanIne wlhlowm
(
flChttKtlrrsb=Ifyouaer Mktg MFlUGdatetoaOrwtIti* llfNgqueatfannaln:.
(the law requ*ree that you Ma an updated mrpieted questionnaire wits the eppraprlae wing sunoro, not later than
September 1 [litre year 1O1. SOO an activity ciesentea In Salon 17n noete), Lona! Ooyarnment Coda, ie pending end
not :alai' Mtn INS 7th businassdayatlet tile eta the originliy fed gtleiiOnrsIDire becomes irrvaiga or tri .l r.t
i
the tonal al entity who make■ rsaw+.nendanens
to a local p.votretent
Name each enrpbyee a oontraetar of gsvanhIeI
Weer ante auywnmeeterenniawshiespoatoseprnitwits ofmoncyAMaeearlbe rteaiflletlonorbeai,ea*labdfarahlg.
Marne each bawl ptrvanRrfarrt orfloerwrtw appoints or ampbr>r local orrrerrrntore officers Or UW gpryaIVentrttel entity kw
n-
Adeseribvthe alHatior]orWditOM 4
WIAohgthqueatiarria eisItterJlm
iv/6,-)
Age/emO1 Ver
05/04/2006 16: 53 3187472914 BITE TERMINATOR LLC PAGE 03/03
05/04/2008 13:29 FAX 979 784 3791 CCS UTILITIES I®oo3
J�c�rce Duda - Conflict Disclosure Statement - Vendor; Ques for n r pdf
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Page 2 !
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or Other person doing beehive with local govemmental entity
FORM CIQ
Pape 2
Nemec( local pwerreoentquiccrwtJteshosh erhea animation abwlnoas refadonahl i (Cv'n044g the section only
If aw dhewer' to A, B, or C ifs Yea.
wasson, tbora a mduding subparts A. ti. cit 0, mutt he completed for each oAfotr wil worn the tier hee.flliet on o
nlstonahip_ Attach adellIonel paces lo this Form C10 as nentssar.1
A. is the Wee; govern ii nt atEcar hatted In filesecton re ting or Doh/tp revive tutabie income Rornlha mer of the
qu..larnahe?
ElYoe
8. 1s the nue Dane quOS110nrtaIre reoeirinu or 11%4 to twelve W 00% I rwon'a eem or 'Otte riir oclorl of TM lord Barr
ooloerWood Intea aacflonAND the MxeDleInmrreI nolfrarnthtlocal governmen+nt"tor
1/43
i=1 YIN
other
C. 'eine IW ofthla roue Iioenaire alfitiabd WIth • Oorprxa&rt or over buMnMSfenthy *at the bail government Dew Oarvea
as anofficerorrtIremr,orroTdianowne nipof10Percent afmora?
Y72 Fb
n Yes
D. Deetnbe eedt Melon lon or tuslness relabonehip.
47.
eigogoro of renal &inn silences with the gCIVCr*><rtintil aruty o�
mow mode*