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Mayo, David R.CONFLICT 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. FORM CIQ OFFICE USE ONLY Date Received " 1. Name of person doing business with local governmental entity. M~ ~`� 55V55M MW xS David R. Mayo • 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 ❑ Lance Simms, Planning & Dev ❑ John Woody, W/WW ❑ Teny Childers, Asst. City Mgr ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Chief Fin. Officer ❑ Charles McLemore, Public Works ❑ Charles McLemore, Public Works El Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Asst. City Mgr ❑ Ed Spillane, Municipal Judge ❑ Cheryl Tumey, Purchasing Mgr. 121 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. ❑ Ron Silvia, Mayor ❑ Ron Gay, Place 3 El David Ruesink, Place 6 City of College Station Elected Officials College Station City Council ❑ Ben White, Place 1 El John Happ. Place 2 ❑ Lynn Mcllhaney, Place 4 El Chris Scotti, Place 5 NONE City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman El Eric Miller El Lois Koontz ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Mary Lind Bryan v4 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 14 NONE ❑ Kevin Myers ❑ Joe Wallace ❑ Frank Cox ❑ David Hart, alternate cig1 NONE ❑ Karen Kasper, Merchant El Valerian Miranda, Architect Cl Rick Lemmons, Business Owner ❑ Joey Dunn, Dir. Planning & Dev 0 Robert Mosley, City Engineer ❑ Eric Barton. CD Coordinator Ig NONE ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice SC NONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton gl NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany IN Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright NONE 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 ❑ Hunter Goodwin O Ward Wells ❑ Robert Raybum, alternate Zoning Board of Adjustments O Joshua Berm ❑ Donald Braune ❑ Derek Dictson ❑ 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 ❑ NONE ❑ John Richards ❑ Charles Taylor IZ( NONE ❑ David Hickson ❑ Glenn Brown, City Manager O Sharon Colson, Chair O Kenny Mallard Research Valley Partnership Board of Directors ❑ Larry Mariott 6i' NONE Wolf Pen Creek TIF Board 0 Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair 0 Marc Chaloupka O 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 0 Susan Lancaster ❑ Nancy Berry g NONE Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayor 1 NONE B/CS Metropolitan Planning Organization 0 Ron Silvia, Mayor Eit NONE BVCOG TMPA Regional Park Project Advisory Board 0 Susan Lancaster 1:21 NONE BVSWMA Policy Advisory Board 0 Ron Silvia, Mayor 0 Susan Lancaster lS1 NONE ❑ Ron Silvia NONE ❑ Nancy Berry 21 NONE ❑ Nancy Berry CA NONE City Center Committee ❑ Ben White 0 Nancy Berry Intergovernmental Committee ❑ Ben White ❑ John Happ Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Ron Gay [$ NONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI a NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Wolf Pen Creek Oversight Committee ❑ Ron Gay ❑ Chris Scotti ll NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: Alan King of the Design Review Board is part of the proposed team for this project. This project should not be reviewed by this board, but if it is, Alan will recuse himself. I have no other former or current affiliation or busines relationship with Alan King. 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. Signature of person doing business ylith the governmental entity 7/2i Date Adopted 01/13/06