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Gulf States Protective Coating, Inc.CONFLICT OF INTEREST For vendor or other person doing QUESTIONNAIRE ss with rn ocal g mental 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. FORM CIQ OFFICE USE ONLY Date Received 2. Check this box if you are filing b an update to a previously filed questionnaire. [1:1 (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 au 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 over � M entity with respect to expenditure of money. g omental ❑ 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 ❑ key Dunn, Planning & Dev ❑ Don Fazzino, Legislative Liason ❑ Charles Wood, Economic Dev ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Finance NONE O Charles McLemore, Public Works O 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 frith a person who is aa who appoints or employs a local government officer of the local government local government officer and this questionnaire,entity that is the subject of City of College Station Elected Officials College Station City Council ❑ Ron Silvia, Mayor ❑ Ben White, Place 1 ❑ Ron Gay, Place 3 0 Susan Lancaster, Place 4 ❑ Nancy Berry, Place 6 ,NONE City of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 ❑ Larry Ringer, Chairman ❑ Eric Miller ❑ Lois Koontz ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev ,'_NONE ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford 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 ❑ Don Schen. ❑ Jo Berg pk_NONE ❑ Kevin Myers ❑ Joe Wallace ❑ Frank Cox ❑ David Hart, alternate ,NONE El Valerian Miranda, Architect ❑ Rick Lernrnons, Business Owner ❑ Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator Historic Preservation Committee ❑ Hillary Jessup, Chairman 0 Bill Lancaster ❑ Marguerite Anthony 0 David Ruesuilc ❑ Thomas Taylor 0 Ernie Wright El Colleen Risinger NONE ❑ Rebecca Eplen ❑ Rusleen Maurice ,.NONE ❑ Kathleen Ireland O Carol Blaschke O John Crompton LNONE. Joint Relief Funding Review Committee El J. Kevin Byrne 0 Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission 0 Scott Shafer, Chairman El John Nichols ❑ Marsha Sanford ❑ Dennis Christiansen ❑ Harold Strong ;SONE Design Review Board ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood El Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Rick Heany 0 Hunter Goodwin ❑ Alan King ❑Nancy Sawtelle 0 Ward Wells 0 Scott Shafer El Susie Cox, alternate ❑ Robert Rayburn, alternate ,NONE Zoning Board of Adjustments 0 Jay Goss, Chair 0 Joshua Benn 0 John Richards 0 Graham Sheffy 0 Donald Braune ElDenise Whisenant ❑Charles Taylor 0 Derek Dictson NONE ❑ David Hickson 0 Lam' Marion City Manager NONE ❑ Glenn Brown, 0 Chris Scotti, Councilman Research Valley Partnership Board of Directors Wolf Pen Creek TIF Board ❑ Sharon Colson, Chair 0 Marsha Sanford, Vice Chair 0 Kenny Mallard 0 Marc Chaloupka 0 James Massey 32tNONE The following individuals are appointed by the City Council to represent the City of Colle e joint committees with other governmental agencies and community groups. g Station on Brazos County Health Department 0 Susan Lancaster 0 Nancy Berry NNONE Brazos Valley Council of Governments Board of Directors 0 Ron Silvia, Mayor P,NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor D124NONE BVCOG TMPA Regional Park Project Advisory Board 0 Susan Lancaster `NONE ❑ Ron Silvia, Mayor 0 Susan Lancaster OcNONE BVSWMA Policy Advisory Board ❑ Ron Silvia 7 NONE ❑ Nancy Berry 'NONE ❑ Nancy Berry (NONE 0 Ron Gay O Ron Gay O Linda LaSuit, MPO O Bryan Woods, TxDOT City Center Committee 0 Ben White Intergovernmental Committee 0 Ben White Joint City/School Intergovernmental Committee 0 Ben White Sister Cities Association NONE Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI pikQy'ONE 0 Nancy Berry 0 John Happ 0 John Happ ❑ Iden Fogle O Michael Parker, BVCOG Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01/13/06 CONFLICT OF INTEREST For vendor or other person doing QUESTIONNAIRE sine TvOlocal AIRE r la amental entity FORM CIQ 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 5. Name of local government officer with whom filer ha as necessary. this section only if the answer to A, B, or C is YES, s affiliation or business relationship. (Complete A. Is the local ,government officer named in this section receiving or likely to receive filer of the questionnaire? taxable income from the Yes No B. Is the filer of the questionnaire receiving B isl g or likely to receive taxable income from or at the direction of the 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. Signature of person doing business with the,ovemmenta[ entity �P H. C t_9 Date Adopted 01/13/06