Brazos Valley Community Action AgencyCONFLICT 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.
2.
k R W A -12 -(3 -EP
FORM CIQ
OFFICE USE ONLY
Date Received
cA r" r -c -T"(\( I E l`rLY
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
❑ Don Fazzino, Legislative Liason
❑ Kim Foutz, Economic Dev
❑ Connie Hooks, City Secretary
LI Jeff Kersten, Finance
>KONE
Describe each affiliation or business re
❑ Charles McLemore, Public Works
❑ Becky Nugent, Public Relations
❑ Julie O'Connell, Human Resources
❑ Mark Smith, Public Works
❑ Ed Spillane, Municipal Judge
❑ Cheryl Turney, Purchasing Mgr.
ationsllip 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
'to appoints or employs a local government officer of the local government entity that is the subject of
..iiS questionnaire.
City of College Station Elected Officials
College Station City Council
❑ Ron Silvia, Mayor ❑ Ben White, Place 1
❑ Ron Gay, Place 3 Cl Susan Lancaster, Place 4
Cl Nancy Berry, Place 6 NONE
❑ John Happ, Place 2
❑ Chris Scotti, Place 5
City of College Station Committees, Boards, and Commissions
B/CS Library Committee
❑ Larry Ringer, Chairman ❑ Katherine Edwards 0 Don Scherr
❑ Eric Miller El Jeanne Mitchell ❑ Jo Berg
❑ Lois Koontz ❑ James Bradford ", NONE
Cemetery Committee
❑ Sarah Adams, Chair Cl Virginia Reese
❑ James Batenhorst ❑ Mary Lind Bryan
❑ David Chester NONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
❑ Kevin Myers
❑ Joe Wallace
❑ Dan B. Sears, Chairman ❑ George McLean, Vice Chair ❑ Frank Cox
❑ Mike Lane ❑ Larry D. Patton ❑ David Hart, alternate
❑ Steve Parker, alternate El David Ruesink, alternate I�IONE
❑ Karen Kasper, Merchant
Joey Dunn, Dir. Planning & Dev
NONE
Facade Improvement Program
Advisory Committee
O Valerian Miranda, Architect ❑ Rick Lemmons, Business Owner
❑ Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator
4. Describe each affiliation or business relationship with a person who is a local government officer and
ho appoints or employs alocal government officer of the local government entity that is the subject of
..lis 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 ❑ John Happ, Place 2
❑ Susan Lancaster, Place 4 ❑ Chris Scotti, Place 5
NONE
City of College Station Committees, Boards, and Commissions
B/CS Library Committee
❑ Larry Ringer, Chairman ❑ Katherine Edwards ❑ Don Scherr
❑ Eric Miller ❑ Jeanne Mitchell ❑ Jo Berg
❑ Lois Koontz ❑ James Bradford NONE
Cemetery Committee
❑ Sarah Adams, Chair ❑ Virginia Reese
❑ Jame Batenhorst 0 Mary Lind Bryan
❑ David Chester 'NONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
❑ Kevin Myers
❑ Joe Wallace
❑ Dan B. Sears, Chairman ❑ George McLean, Vice Chair ❑ Frank Cox
❑ Mike Lane ❑ Larry D. Patton 0 David Hart, alternate
❑ Steve Parker, alternate ❑ David Ruesink, alternate `TONE
❑ Karen Kasper, Merchant
• Joey Dunn, Dir. Planning & Dev ❑ Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator
NONE
Facade Improvement Program
Advisory Committee
❑ Valerian Miranda, Architect ❑ Rick Lemmons, Business Owner
Historic Preservation Committee
❑ Hillary Jessup, Chairman ❑ Bill Lancaster
❑ Marguerite Anthony ❑ David Ruesink
❑ Thomas Taylor ❑ Ernie Wright
❑ Colleen Risinger > NONE
❑ Rebecca Eplen
❑ Rusleen Maurice
4ONE
❑ Kathleen Ireland
❑ Carol Blaschke
7 John Crompton
`21<ON E
Joint Relief Funding Review
Committee
❑ J. Kevin Byrne
❑ Charlotte Mikulee
Parks and Recreation Board
❑ Glenn Schroeder
O Jeannie McCandless
O Harry Green
Planning and Zoning
Commission
❑ Scott Shafer, Chairman 0 John Nichols
❑ Marsha Sanford 0 Dennis Christiansen
O Harold Strong `�-NONE
Design Review Board
❑ Marsha Crenwelge
❑ Dipankar Sen
❑ Neal Nutall, Jr.
❑ Mary Sherwood
❑ Peggy Samson
O Jodi Warner
O Gary Thomas
O Gary Erwin
O Ken Reynolds
O Bill Davis
❑ Rick Heany 0 Hunter Goodwin 0 Nancy Sawtelle
❑ Alan King 0 Ward Wells ❑ Scott Shafer
❑ Susie Cox, alternate 0 Robert Rayburn, alternate TONE
❑ Jay Goss, Chair
I Graham Sheffy
O Denise Whisenant
Zoning Board of Adjustments
❑ Joshua Benn ❑ John Richards
❑ Donald Braune 0 Charles Taylor
O Derek Dictson NONE
Research Valley Partnership
Board of Directors
❑ David Hickson ❑ Larry Mariott
❑ Glenn Brown, City Manager 1% ---NONE
❑ Sharon Colson, Chair
❑ Kenny Mallard
Wolf Pen Creek TIF Board
❑ Chris Scotti, Councilman
❑ Marsha Sanford, Vice Chair ❑ Marc Chaloupka
❑ 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.
Brazos County Health
Department
❑ Susan Lancaster Cl Nancy Berry NONE
Brazos Valley Council of
Governments Board of Directors
❑ Ron Silvia, Mayor NONE
B/CS Metropolitan Planning
Organization
❑ Ron Silvia, Mayor NONE
BVCOG TMPA Regional Park
Project Advisory Board
❑ Susan Lancaster NONE
BVSWMA Policy Advisory
Board
❑ Ron Silvia, Mayor 0 Susan Lancaster NONE
❑ Ron Silvia
jNON E
❑ Nancy Berry
NONE
❑ Nancy Berry
Qst NONE
❑ Ron Gay
City Center Committee
❑ Ben White ❑ Nancy Berry
Intergovernmental Committee
❑ Ben White- ❑ John Happ
Joint City/School
Intergovernmental Committee
O Ben White 0 John Happ
Sister Cities Association
ikt'NONE
Transportation Committee
O Ron Gay 0 John Happ
❑ Linda LaSuit, MPO ❑ Dennis Christianson, TTI
O Bryan Woods, TxDOT NONE
❑ Ken Fogle
O Michael Parker, BVCOG
Describe each affiliation or business relationship with an employee checked in Question 4 above:
Adopted 01/13/06
Wolf Pen Creek Oversight
Committee
❑ Chris Scotti
jzl',"NONE
■ Ron Gay
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
'his 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
)vernment 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.
11-6
Signa of person doing business ith the governmental entity Date
Adopted 01/13/06