McClure & Browne Engineering / SurveyingCONFLICT 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.
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.
Name of person doing business with local governmental entity.
McClure & Browne Engineering/Surveying, Inc.
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.)
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.
See attached
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.
Unkown
Adopted 71/02/2005
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with local governmental entity
FORM CIQ
Page 2
J Name of local government officer with whom filer has affilitation or business relationship. (Complete this section only if the
answer to A, B, or C is YES.)
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.
A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the
questionnaire?
Yes
X
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
X
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
X
No
D. Describe each affiliation or business relationship.
May 22, 2006
ignature of person doing business the governmental entity Date
Adopted 11/02/2005
Conflict of Interest Questionnaire Form CIQ
City of College Station
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.
Anyone in Development Services, Public Works, and/or Utility Services