MMG DisposalCONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
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.
OFFICE USE ONLY
Date Received
1. Name of person doing business with local governmental entity.
muYillo Mnd,.icu- 61r (VI) dyL
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 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
❑ David Massey, Electric
❑ Michael Clancey, Police Chief ❑ Charles McLemore, Public Works
❑ Lance Simms, Planning & Dev ❑ Becky Nugent, Public Relations
❑ John Woody, W/WW ❑ Julie O'Connell, Human Resources
❑ Charles Wood, Economic Dev 0 Mark Smith, Special Projects
❑ Connie Hooks, City Secretary 0 Ed Spillane, Municipal Judge
❑ Jeff Kersten, Finance ❑ Cheryl Turney, Purchasing Mgr.
❑ Charles McLemore, Public Works NONE
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
❑ Ron Silvia, Mayor ❑ Ben White, Place 1
❑ Ron Gay, Place 3 ❑ Lynn Mcllhaney, Place 4
❑ David Ruesink, Place 6 XNONE
❑ 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 ❑ Don Scherr
❑ Eric Miller ❑ Jeanne Mitchell ❑ Jo Berg
❑ Lois Koontz ❑ James Bradford NONE
❑ Sarah Adams, Chair
❑ James Batenhorst
❑ David Chester
❑ Dan B. Sears, Chairman
❑ Mike Lane
❑ Steve Parker, alternate
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
❑ Kevin Myers
❑ Joe Wallace
❑ Frank Cox
❑ David Hart, alternate
'0 NONE
❑ Karen Kasper, Merchant ❑ Valerian Miranda, Architect ❑ Rick Lemmons, Business Owner
❑ Joey Dunn, Dir. Planning & Dev ❑ Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator
4 NONE
Historic Preservation Committee
❑ Hillary Jessup, Chairman ❑ Bill Lancaster
❑ Marguerite Anthony ❑ David Ruesink
❑ Thomas Taylor ❑ Ernie Wright
❑ Colleen Risinger Al NONE
❑ Rebecca Eplen
❑ Rusleen Maurice
X NONE
❑ Kathleen Ireland
❑ Carol Blaschke
El John Crompton
NONE
❑ Scott Shafer, Chairman
❑ Marsha Sanford
❑ Harold Strong
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
NONE
Design Review Board
❑ Marsha Crenwelge
❑ Dipankar Sen
❑ Neal Nutall, Jr.
❑ Mary Sherwood
❑ Peggy Samson
❑ Jodi Warner
❑ Gary Thomas
❑ Gary Erwin
❑ Ken Reynolds
❑ Bill Davis
❑ Rick Heany ❑ Hunter Goodwin ❑ Nancy Sawtelle
❑ Alan King ❑ Ward Wells ❑ Scott Shafer
❑ Susie Cox, alternate ❑ Robert Rayburn, alternate 1;2;\ NONE
Zoning Board of Adjustments
❑ Jay Goss, Chair ❑ Joshua Benn ❑ John Richards
❑ Graham Sheffy ❑ Donald Braune ❑ Charles Taylor
❑ Denise Whisenant ❑ Derek Dictson NONE
❑ David Hickson
❑ Glenn Brown, City Manager
❑ Sharon Colson, Chair
❑ Kenny Mallard
Research Valley Partnership
Board of Directors
❑ Larry Mariott
NONE
Wolf Pen Creek TIF Board
❑ Chris Scotti, Councilman
❑ Marsha Sanford, Vice Chair ❑ Marc Chaloupka
0 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 0 Nancy Berry NONE
Brazos Valley Council of
Governments Board of Directors
O Ron Silvia, Mayor NONE
B/CS Metropolitan Planning
Organization
O Ron Silvia, Mayor g NONE
BVCOG TMPA Regional Park
Project Advisory Board
O Susan Lancaster ./4 NONE
BVSWMA Policy Advisory
Board
111 Ron Silvia, Mayor 0 Susan Lancaster L NONE
❑ Ron Silvia
NONE
O Nancy Berry
NONE
O Nancy Berry
A NONE
O Ron Gay
❑ Ron Gay
❑ Linda LaSuit, MPO
O Bryan Woods, TxDOT
City Center Committee
❑ Ben White 0 Nancy Berry
Intergovernmental Committee
O Ben White 0 John Happ
Joint City/School
Intergovernmental Committee
O Ben White 0 John Happ
Sister Cities Association
,NONE
Transportation Committee
O John Happ
❑ Dennis Christianson, TTI
NONE
❑ Ken Fogle
O Michael Parker, BVCOG
Wolf Pen Creek Oversight
Committee
O Ron Gay
❑ Chris Scotti
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
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
No
D. Describe each affiliation or business relationship.
6.
C,/ig/ex,
ignature of person doing business with the governmental entity Date
Adopted 01/13/06