Associates Recievable ConsultantsCONFLICT 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 conunitts 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.
c/q e/
2.
FORM CIQ
OFFICE USE ONLY
Date Received
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
El Olivia Burnside, In£ Tech.
❑ Pete Caler, Landfill Mgr.
❑ Harvey Cargill, City Attorney
❑ David Massey, Electric
El Michael Clancey, Police Chief
❑ Lance Simms, Planning & Dev
❑ John Woody, W/WW
❑ Terry Childers, Asst. City Mgr
El Connie Hooks, City Secretary
❑ Jeff Kersten, Chief Fin.Officer
❑ Charles McLemore, Public Works
❑ Becky Nugent, Public Relations
❑ Julie O'Connell, Human Resources
❑ Mark Smith, Asst. City Mgr
❑ Ed Spillane, Municipal Judge
❑ Cheryl Turney, Purchasing Mgr.
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
❑ David Ruesink, Place 6
City of College Station Elected Officials
College Station City Council
❑ Ben White, Place 1
❑ Lynn Mcllhaney, Place 4
$ NONE
❑ John Happ, Place 2
❑ Chris Scotti, Place 5
City of College Station Committees, Boards, and Commissions
❑ Larry Ringer, Chairman
❑ Mary Fran Troy
❑ Jennifer Bohac
❑ Sarah Adams, Chair
❑ James Batenhorst
❑ David Chester
❑ Donald Braune
❑ Dan B. Sears, Chairman
❑ Mike Lane
❑ Steve Parker, alternate
B/CS Library Committee
❑ Katherine Edwards
❑ Jeanne Mitchell
❑ James Bradford
Cemetery Committee
❑ Virginia Reese
❑ Weldon Kruger
❑ RC SIocum
4 NONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
❑ Don Scherr
❑ B. Carroll Johnson
;18( NONE
❑ Kevin Myers
❑ Joe Wallace
❑ James Matson
❑ George McLean, Vice Chair ❑ Frank Cox
❑ Larry D. Patton ❑ David Hart, alternate
❑ David Ruesink, alternate NONE
❑ Hillary Jessup, Chairman
❑ Haskell Monre
❑ Ernie Wright
NONE
❑ Rebecca Eplen
❑ Rusleen Maurice
NONE
❑ Jodi Warner, Chair
❑ Shawn Rhodes
❑ John Crompton
. NONE
Historic Preservation Committee
❑ Bill Lancaster
❑ Dipankar Sen
❑ Neal Nutall, Jr.
Joint Relief Funding Review
Committee
❑ J. Kevin Byrne
❑ Charlotte Mikulee
Parks and Recreation Board
❑ Kathleen Ireland
❑ Jody Ford
❑ Harry Green
Planning and Zoning
Commission
❑ John Nichols, Chair ❑ Glenn Schroeder
❑ Marsha Sanford ❑ Dennis Christiansen
❑ Harold Strong .,r, NONE
Design Review Board
❑ Marguerite Anthony
❑ Thomas Taylor
O Colleen Risinger
❑ Deborah Deitering
O Peggy Samson
❑ Joan Perry
El Gary Thomas
O Gary Erwin
❑ Derek Dictson
O Bill Davis
El Rick Heany ❑ Hunter Goodwin ❑ Nancy Sawtelle
❑ Alan King 0 Ward Wells ❑ John Nichols
❑ Susie Cox, alternate ❑ Robert Rayburn. alternate NONE
❑ Jay Goss, Chair
❑ Denise Whisenant
/NONE
Zoning Board of Adjustments
❑ Joshua Berm
0 Donald Braune
❑ John Richards
❑ Thomas Mather
❑ Larry Hodges
O Glenn Brown, City Manager
O Sharon Colson, Chair
O Kenny Mallard
Research Valley Partnership
Board of Directors
❑ Larry Mariott
NONE
Wolf Pen Creek TIF Board
0 Chris Scotti, Councilman
❑ Marsha Sanford, Vice Chair 0 Marc Chaloupka
❑ James Massey ,r4 NONE
Outside Agency Funding Review
❑ Don Lewis ❑ Charles Taylor
❑ Gregg Baird 0 Sheryl Welford
O Chad Jones %NONE
❑ Roger Reese
O Carolyn Berrow
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
O Lynn Mcllhaney ❑ Ben White 'NONE
Brazos Valley Council of
Governments
❑ Ron Silvia, Mayor NONE
B/CS Metropolitan Planning
Organization
O Ron Silvia, Mayor g NONE
BVCOG TMPA Regional Park
Project Advisory Board
❑ Lynn Mcllhaney citNONE
BVSWMA Policy Advisory
Board
O Ron Silvia, Mayor ❑ Chris Scotti 4 NONE
City Center Committee
❑ Ron Silvia 0 Ben White 0 Dave Ruesink
%NONE
Intergovernmental Committee
❑ Ron Gay 0 Ben White ❑ John Happ
X NONE
❑ Dave Ruesink
X NONE
Joint City/School
Intergovernmental Committee
0 Ben White 0 John Happ
Sister Cities Association
O Dave Ruesink NONE
Transportation Committee
O Ron Gay 0 John Happ 0 Lynn McIlhaney
❑ Ken Fogle 0 Linda LaSuit, MPO 0 Dennis Christianson, TTI
O Michael Parker, BVCOG 0 Bryan Woods, TxDOT k NONE
O Ron Gay
Wolf Pen Creek Oversight
Committee
0 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
x
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
i� — C,� —
with the governmental entity Date
Adopted 01/13/06