Mejorando Group, TheCONFLICT OF INTEiEST QUESTIONNAIRE FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire is being fi ed in accordance with chapter 176 of the Local
Government Code by a persol 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.
2.
rye._ d bc, The nig.) Druid 6dLf
Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file ar updated completed questionnaire with the appropriate filing authority not later than
September 1 of the year for whici an activity described in Section 176.006(a), Local Government Code, is pending and
not later than the 7th business da' after the date the originally filed questionnaire becomes incomplete or inaccurate.)
3. Describe each affiliation dr 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
O Olivia Burnside, Inf. Tech.
❑ Pete Caler, Landfill Mgr.
❑ Harvey Cargill, City Attorny
O David Massey, Electric
❑ Michael Clancey, Police Chief
❑ Lance Simms, Planning & Dev
❑ John Woody, W/WW
❑ Terry Childers, Asst. City Mgr
❑ Connie Hooks, City Secretary
❑ Jeff Kersten, Chief Fin.Officer
❑ Charles McLemore, Public Works
O Becky Nugent, Public Relations
l''Julie O'Connell, Human Resources
❑ Mark Smith, Asst. City Mgr
❑ Ed Spillane, Municipal Judge
❑ Cheryl Turney, Purchasing Mgr.
O NONE
Describe each affiliation or business relationship with an employee checked in Question 3 above:
ii Q j S Mk i n cI 0 E 604 dor S u CCe JS i m Plan n1 h13 Sef vt res
4. Describe each affiliation
who appoints or employs a
this questionnaire.
❑ Ron Silvia, Mayor
❑ Ron Gay, Place 3
❑ David Ruesink, Place 6
or business relationship with a person who is a local government officer and
ocal government officer of the local government entity that is the subject of
City of College Station Elected Officials
College Station City Council
❑ Ben White, Place 1
❑ Lynn McIlhaney, Place 4
y NONE
City of College Station Committees, Boards, and Commissions
❑ John Happ, Place 2
❑ Chris Scotti, Place 5
❑ Larry Ringer, Chairman
❑ Eric Miller
❑ Lois Koontz
❑ Sarah Adams, Chair
❑ James Batenhorst
❑ David Chester
O Dan B. Sears, Chairman
O Mike Lane
❑ Steve Parker, alternate
B/CS Library Committee
❑ Katherine Edwards
❑ Jeanne Mitchell
❑ James Bradford
Cemetery Committee
❑ Virginia Reese
❑ Mary Lind Bryan
l 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 Scherr
❑ Jo Berg
/ NONE
O Kevin Myers
O Joe Wallace
❑ Frank Cox
❑ David Hart, alternate
y NONE
❑ Karen Kasper, Merchant 0 Valerian Miranda, Architect 0 Rick Lemmons, Business Owner
❑ Joey Dunn, Dir. Planning & 1 ev 0 Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator
O NONE
❑ Hillary Jessup, Chairman
O Marguerite Anthony
❑ Thomas Taylor
❑ Colleen Risinger
❑ Rebecca Eplen
O Rusleen Maurice
7 NONE
❑ Kathleen Ireland
❑ Carol Blaschke
❑ John Crompton
sit NONE
O Scott Shafer, Chairman
O Marsha Sanford
O Harold Strong
❑ Rick Heany
❑ Alan King
O Susie Cox, alternate
O Jay Goss, Chair
O Graham Sheffy
❑ Denise Whisenant
Historic Preservation Committee
❑ Bill Lancaster
❑ David Ruesink
O Ernie Wright
41 NONE
Joint Relief Funding Review
Committee
O J. Kevin Byrne
O Charlotte Mikulee
Parks and Recreation Board
❑ Glenn Schroeder
❑ Jeannie McCandless
❑ Harry Green
Planning and Zoning
Commission
❑ John Nichols
❑ Dennis Christiansen
l NONE
Design Review Board
❑ Hunter Goodwin
O Ward Wells
❑ Robert Rayburn, alternate
❑ Marsha Crenwelge
❑ Dipankar Sen
❑ Neal Nutall, Jr.
O Mary Sherwood
❑ Peggy Samson
❑ Jodi Warner
❑ Gary Thomas
❑ Gary Erwin
❑ Ken Reynolds
O Bill Davis
❑ Nancy Sawtelle
❑ Scott Shafer
NONE
Zoning Board of Adjustments
O Joshua Benn 0 John Richards
O Donald Braune 0 Charles Taylor
O Derek Dictson 17NONE
Research Valley Partnership
Board of Directors
❑ David Hickson ❑ Larry Mariott
❑ Glenn Brown, City Mana; er fl NONE
❑ Sharon Colson, Chair
❑ Kenny Mallard
The following individuals a
Wolf Pen Creek TIF Board
El Chris Scotti, Councilman
❑ Marsha Sanford, Vice Chair ❑ Marc Chaloupka
0 James Massey L 'NONE
appointed by the City Council to represent the City of College Station on
joint committees with other overnmental agencies and community groups.
❑ Susan Lancaster
❑ Ron Silvia, Mayor
❑ Ron Silvia, Mayor
❑ Susan Lancaster
❑ Ron Silvia, Mayor
Brazos County Health
Department
❑ Nancy Berry NONE
Brazos Valley Council of
Governments Board of Directors
�1 NONE
B/CS Metropolitan Planning
Organization
111 NONE
BVCOG TMPA Regional Park
Project Advisory Board
NONE
BVSWMA Policy Advisory
Board
0 Susan Lancaster 7 NONE
❑ Ron Silvia
Ti NONE
❑ Nancy Berry
ja NONE
❑ Nancy Berry
V NONE
0 Ron Gay
❑ Ron Gay
❑ Linda LaSuit, MPO
❑ Bryan Woods, TxDOT
City Center Committee
❑ Ben White ❑ Nancy Berry
Intergovernmental Committee
O Ben White ❑ John Happ
Joint City/School
Intergovernmental Committee
❑ Ben White ❑ John Happ
Sister Cities Association
la NONE
Transportation Committee
❑ John Happ
❑ Dennis Christianson, TTI
el NONE
❑ Ken Fogle
❑ Michael Parker, BVCOG
Wolf Pen Creek Oversight
Committee
O Ron Gay
O Chris Scotti
Z1 NONE
Describe each affiliation or bus
ness 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 governmeit officer with whom filer has affiliation or business relationship. (Complete
this section only if the answer to A, B, or C is YES.
Lk1 i t 0' Coin r\ - t
A. Is the local government o
filer of the questionnaire?
Yes
icer named in this section receiving or likely to receive taxable income from the
VI
No
B. Is the filer of the questionn ire receiving or likely to receive taxable income from or at the direction of the
local government officer nam d in this section AND the taxable income is not from the local governmental
entity?
Yes
No
C. Is the filer of this questionniiire 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
D. Describe each affiliation or
J
No
business relationship.
eu✓t�cccf Oe/Jut)
JueceJildri elan V71,3 SD!J1C 3.
6.
Signature of person doing busin
ss with the governmental entity Date
Adopted 01/13/06