Harpole, JohnCONFLICT 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.
1. Name of person doing business with local governmental entity.
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2.
FORM CIQ
OFFICE USE ONLY
Date Received
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
❑ 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
O Don Fazzino, Legislative Liason
❑ Kim Foutz, Economic Dev
❑ Connie Hooks, City Secretary
❑ Jeff Kersten, Finance
[NONE
O Charles McLemore, Public Works
❑ Becky Nugent, Public Relations
❑ Julie O'Connell, Human Resources
❑ Mark Smith, Public Works
❑ Ed Spillane, Municipal Judge
O Cheryl Turney, Purchasing Mgr.
Describe each affiliation or business relationship with an employee checked in Question 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.
City of College Station Elected Officials
College Station City Council
El Ron Silvia, Mayor El Ben White, Place 1
E l Ron Gay, Place 3 0 Susan Lancaster, Place 4
❑ Nancy Berry, Place 6 [NONE
El John Happ, Place 2
El Chris Scotti, Place 5
City of College Station Committees, Boards, and Commissions
B/CS Library Committee
❑ Larry Ringer, Chairman ❑ Katherine Edwards ❑ Don Schen
❑ Eric Miller ❑ Jeanne Mitchell 0 Jo Berg
El Lois Koontz El James Bradford ft -NONE
Cemetery Committee
El Sarah Adams, Chair ❑ Virginia Reese
❑ James Batenhorst El Mary Lind Bryan
❑ David Chester!la'NONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
❑ Kevin Myers
El Joe Wallace
El Dan B. Sears, Chairman El George McLean, Vice Chair ❑ Frank Cox
El Mike Lane ❑ Larry D. Patton ❑ David Hart, alternate
El Steve Parker, alternate El David Ruesink, alternate DONE
Facade Improvement Program
Advisory Committee
❑ Karen Kasper, Merchant ❑ Valerian Miranda, Architect El Rick Lemmons, Business Owner
E❑ Joey Dunn, Dir. Planning & Dev El Robert Mosley, City Engineer El Eric Barton, CD Coordinator
NONE
❑ Hillary Jessup, Chairman
❑ Marguerite Anthony
❑ Thomas Taylor
O Colleen Risinger
❑ Rebecca Eplen
❑ R5usleen Maurice
VNONE
O Kathleen Ireland
❑ Carol Blaschke
❑ John Crompton
NONE
❑ Scott Shafer, Chairman
El Marsha Sanford
O Harold Strong
❑ Rick Heany
❑ Alan King
❑ Susie Cox, alternate
El Jay Goss, Chair
O Graham Sheffy
❑ Denise Whisenant
Historic Preservation Committee
❑ Bill Lancaster
El David Ruesink
O Ernie Wright
ild' NONE
Joint Relief Funding Review
Committee
❑ J. Kevin Byrne
El Charlotte Mikulee
Parks and Recreation Board
❑ Glenn Schroeder
❑ Jeannie McCandless
❑ Harry Green
Planning and Zoning
Commission
O John Nichols
O Dennis Christiansen
ale<ONE
Design Review Board
❑ Hunter Goodwin
❑ Ward Wells
❑ Robert Rayburn, alternate
❑ Marsha Crenwelge
❑ Dipankar Sen
❑ Neal Nutall, Jr.
❑ Mary Sherwood
❑ Peggy Samson
❑ Jodi Warner
❑ Gary Thomas
❑ Gary Erwin
❑ Ken Reynolds
❑ Bill Davis
❑ Nancy Sawtelle
❑ Scott Shafer
DONE
Zoning Board of Adjustments
❑ Joshua Benn 0 John Richards
❑ Donald Braune ❑ Charles Taylor
❑ Derek Dictson VKI ONE
Research Valley Partnership
Board of Directors
❑ David Hickson �❑ Larry Mariott [
0 Glenn Brown, City Manager ONE
❑ Sharon Colson, Chair
❑ Kenny Mallard
Wolf Pen Creek TIF Board
❑ Chris Scotti, Councilman
❑ Marsha Sanford, Vice Chair 0 Marc Chaloupka
❑ James Massey 11KONE
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
❑ Susan Lancaster ❑ Nancy Berry UKVONE
Brazos Valley Council of
Governments Board of Directors
0 Ron Silvia, Mayor 144NE
B/CS Metropolitan Planning
Organization
❑ Ron Silvia, Mayor Ep4 ONE
BVCOG TMPA Regional Park
Project Advisory Board
❑ Susan Lancaster NONE
BVSWMA Policy Advisory
Board
0 Ron Silvia, Mayor 0 Susan Lancaster SONE
❑ Ron Silvia
P4 ONE
❑ Nanc Berry
4.1•16NE
��❑ Nancy Berry
�LYNONE
❑ Ron Gay
❑ Ron Gay
❑ Linda LaSuit, MPO
❑ Bryan Woods, TxDOT
City Center Committee
❑ Ben White ❑ Nancy Berry
Intergovernmental Committee
❑ Ben White 0 John Happ
Joint City/School
Intergovernmental Committee
0 Ben White 0 John Happ
Sister Cities Association
Lot" NONE
Transportation Committee
❑ John Happ
❑ Dennis Christianson, TTI
IG�'NONE
❑ Ken Fogle
❑ Michael Parker, BVCOG
Wolf Pen Creek Oversight
Committee
O Ron Gay
0 Chris Scotti
Et 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 I // I 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 I r /I No
D. Describe each affiliation or business relationship.
6.
gnature of person dot g business with the governmental entity
Date
Adopted 01/13/06