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Rios Tree Service, Inc.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. 1. Name of person doing business with local governmental entity. 2. EllCheck 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 authoritynot September 1 of the year for which an activity described in Section 176.006(a), Local l Government Code, ispending and not later than the 7th business day after the date the originally filed questionnaire becomes incomplete later than p or inaccurate.) 3. Describe each affiliation or businesseM s relationship with an employee or contractor of the o entity with respect to expenditure of money. governmental entity who makes recommendations to a local government officer of the local governmental FORM CIQ ❑ Robert Alley, Fire Chief 0 ❑ Steve Beachy, Parks & Rec 0 ❑ Glenn Brown, City Manager ❑ D Olivia Burnside, Inf. Tech. ❑ D Pete Caler, Landfill Mgr. 0 ❑ Harvey Cargill, City Attorney 0 D NONE Michael Clancey, Police Chief 0 Lance Simms, Planning & Dev 0 John Woody, W/WW Terry Childers, Depu ity Mgr Connie Hocks City Secretary Jef€•Kersten, Ch ief Fin.Officer Becky Nugent, Public Relations Juli onnell, Human Resources Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. O David Ma ssey, Electric 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 localovernme who appoints or employs a local government officer of the local government entity that is this questionnaire, is tha n subject of City of College Station Elected Officials College Station Ci Council ❑ Ron Silvia, Mayor ❑ Ron Gay, Place 3 ❑ David Ruesink, Place 6 ❑ Larry Ringer, Chairman O Mary Fran Troy ❑ Jennifer Bohac ❑ es Bradford ❑ Ben I ' -, Place 1 ❑ nn Mcllhaney, Place 4 ❑ NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ Katherine Edward O Jeanne ell ❑ Sarah Adm, Chair ❑ James Batenhorst ❑ David Chester ❑ Donald Braune ❑ Dan B. Sears, Chairman ❑ Frank Cox, ❑ Mike Lane ❑ .L,D. Patton 0 Steve Parker, alternate 0 Glenn Thomas, alternate 0 NONE Cemetery Committee ❑ Virginia Reese ❑ Weldo • ruger Slocum ❑ NONE Construction Board of Adjustments and Appeals/Building & Standard Commission ❑ Don Scherr ❑ B. Carroll Johnson ❑ NONE ❑ Kevin Myers ❑ Joe Wallace ❑ James Matson ❑ David Hart ❑ Charles Thomas, alternate O Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright ❑ NONE ❑ Rebecca Eplen ❑ Rusleen Maurice ❑ NONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton ❑ NONE P Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey ❑ Neal ► . all, Jr. Joint Relief Funding Review Committee ❑ J. Kevin B ❑ C - otte Mikulee Parks and Recreation Board ❑ Kathleen Irelan 0 Jody F ❑ John Nichols, Chair ❑ Marsha Sanford ❑ Harold Strong rry Green Planning and Zonin Commiss 0 Glenn S eder ennis Christiansen 0 NONE ❑ Rick Heany ❑ Alan King ❑ Susie Cox, altern ❑ Jay Goss, Chair ❑ Denise Whisenant O NONE Design R Board ❑ Marguerite Anthony ❑ Meredith Waller ❑ Colleen Risinger ❑ Deborah Deitering ❑ Peggy Samson ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin ❑ Derek Dictson ❑ Bill Davis nter Goodwin 0 Nancy Sawtelle ❑ Ward Wells 0 John Nichols ❑ Robert Rayburn, alternate ❑ NONE Zoning Board of Ad' _ ents ❑ Josh nn ❑ John Richards Donald Braune ❑ Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird ❑ Chad Jones r Research Valley Partnership Board of D. tors 0 Larry ❑ Stephen Syptak, Chair ❑ Tom Kirkland ❑ NONE ❑ Hugh Lindsay, Area I ❑ John Crompton, Area II ❑ Steve Arden, Area III ❑ Hugh Stearns, Area IV ❑ Andrew Burleson, Student Resident ❑ Dorthea Robinson, Alternate, ETJ Resident ❑ Chris Scotti, Councilmember ❑ Hillary Jessup, Histori Preservation ❑ Lloyd Wass Commis on an, County ONE Wolf Pen riott eek TIF Board ❑ ' • sha Sanford, Vice Chair ❑ James Massey Outside Agenc unding Review ❑ es Taylor ❑ Sheryl Welford ❑ NONE No gate Tax Increment Finance Board O David Scarmardo O Glenn Thomas Comprehensive Plan Committee ❑ John Richards, Area I ❑ Brian Bochner, Area II El Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ Kristina Campbell, -mate Student Reside ffaig , ' esident-At-Large Lynn Mcllhaney, Alternate, Councilmember 0 Gary Erwin, Parks & Rec ❑ Larry Haskins, Northgate District Assoc. 0 Chris Scotti, Councilman ❑ Marc Chaloupka ❑ NONE ❑ Roger Reese ❑ Carolyn Berrow ❑ Anne Jackson ❑ Dale O'Riley El David Hart, Al : ate, Area I ❑ Denni ' srrington, Alternate, Area II om Taylor, Alternate, Area III ❑ Adrian Williams, Alternate, Area IV ❑ Douglas Rape', ETJ Resident ❑ Mike Guido, Alternate, Resident -At -Large ❑ Bill Davis, P&Z ❑ Kathleen Ireland, Parks & Rec Alternate 0 Bo Miles, Building & Land Development O Larry Marriott, Home Builders Assoc. ❑ Tedi Ellison, Intergovernmental Comm/Chamber of Commerce O James Massey, Intergovernmental Comm/TAMU Admin O Dr. Clark Ealy, Intergovernment Comm/CSISD ❑ Chuck Martinez lntergove ental Comm/ Resea alley Patnership ❑ Linda LaSut, Intergovernmental Comm/MPO ❑ Lindsey Guindi, Inter Comm/Chamber o merce mental odn eis, Intergovernmental m/TAMU Transit O Dr. Colleen Netterville, Intergovernmental Comm/BISD ❑ Margie Lucas, Intergovernmental Comm/ Brazos Transit District ❑ Chad hne, Intergovernmental omm/TxDOT ❑ Michael Parks, Intergovernmental Comm/B VCOG ❑ Gary Arnold, Intergovernmental Comm/Brazos County Sheriff ❑ Gary Teston, Intergovernmental Comm/ Easterwood Airport 0 NONE The following individuals are appointed by the City Council to represent the City of Coll joint committees with other governmental agencies and community groups.ege Station on Brazos County Health Department 0 Ben White 0 Lynn Mcllhaney Brazos Valley Council of Governments 0 Ron Silvia, Mayor 0 NONE B/CS Metropolitan Planning Organization 0 Ron Silvia, Mayor 0 NONE 0 NONE BVCOG TMPA Region • ' ark Project A s vi ory : and ❑ Lynn Mcllhaney 0 NONE BVS Policy Advisory 0 Ron Silvia, Mayor Board hris Scotti 0 NONE City Center Committee ❑ Ron Silvia 0 Ben White ❑ NONE 0 Dave Ruesink Intergovernmental Committee ❑ Ron G 0 Ben White 0 N i 1 E 0 John Happ ❑ Dave Ruesink O NONE Joint City/School Intergovernmental Committee 0 Ben White Sister Cities Association ❑ Dave Ruesink 0 NONE ❑ Ron Gay ❑ Ken Fogle O Michael Parker, BVCOG ❑ Ron Gay Transportation Commit ❑ John Happ ❑ John Happ 0 Lynn Mcllhaney ❑ Linda LaSuit PO ❑ Dennis Christianson, TTI ❑ Bryan .ods, TxDOT 0 NONE olf Pen Creek Oversight Committee ❑ Chris Scotti ❑ NONE Describe each affil'. ion or business relationship with an employee checked in Question 4 above: Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE 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 has affiliation or other relationship. Attach additional pages to this Form CIQ as nec 5. Name of local government officer with whom filer has affiliation or business this section only if the answer to A, B, or C is YES. FORM CIQ fficer with whom the filer F'MeA essary. relationship. (Complete A. Is the local government officer named in this section receiving or likely to receive taxa filer of the questionnaire? Yes No B. Is the filer of the questionnaire receiving or likely to receiv local government officer named in this section AND the taxa entity? ■ Yes ■ income from the le income from or at the direction of the Income is not from the local governmental C. Is the filer of this questionnaire affi . ted with a corporation or other business entity that the local government officer serves as an of er or director, or holds an ownership of 10 percent or more? f 1 No Y/ D. Describe each filiation or business relationship. LP(4/1 J\I-A— -e-ittiLt,c.e.,, /I/1 c --- Signature of person doing business with the governmental ent. - ru.,.„,ciktikt-- i l/a,.l 0 Date Adopted 01/13/06