Zulkowski WholesaleCONFLICT 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 busin with local governmental entity.
C-014_116 2 u i koceo si
2.
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.
❑ Glenn Brown, City Manager
❑ Robert Alley, Fire Chief
❑ Pete Cater, Landfill Mgr.
❑ David Gwin, Economic Dev.
El David Massey, Electric
❑ Lance Simms, Planning & Dev
❑ Cheryl Turney, Purchasing Mgr.
❑ Terry Childers, Deputy City Mgr
❑ Steve Beachy, Parks & Rec
❑ Harvey Cargill, City Attorney
❑ Connie Hooks, City Secretary
❑ Becky Nugent, Public Relations
❑ Mark Smith, Public Works
❑ John Woody, W/WW
❑ Kathy Merrill, Asst. City Mgr.
❑ Olivia Burnside, Inf. Tech.
❑ Michael Chancey, Police Chief
❑ Jeff Kersten, Chief Fin.Officer
❑ Julie O'Connell, Human Resources
❑ p Spillane, Municipal Judge
cE4NONE
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
0 Ron Gay, Place 3
❑ David Ruesink, Place 6
City of College Station Elected Officials
College Station City Council
❑ Ben White, Place 1
0 Lynn Mcllhaney, Place 4
12/NONE
❑ John Happ, Place 2
❑ Chris Scotti, Place 5
City of College Station Committees, Boards, and Commissions
D Larry Ringer, Chairman
O Mary Fran Troy
O Sonio Margarita Gangotena
❑ Sarah Adams, Chair
O James Batenhorst
El David Chester
❑ Donald Braune
❑ Dan B. Sears, Chairman
❑ Mike Lane
❑/Steve Parker, alternate
d NONE
B/CS Library Committee
❑ Katherine Edwards
❑ Jeanne Mitchell
❑ James Bradford
Cemetery Committee
❑ Virginia Reese
❑ Weldon Kruger
❑ RC Slocum
NONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
❑ Frank Cox
❑ Larry D. Patton
❑ Glenn Thomas, alternate
❑ Don Scherr
❑ B. Carroll Johnson
EA ONE
❑ Kevin Myers
❑ Joe Wallace
❑ James Matson
❑ David Hart
❑ Charles Thomas, alternate
❑ Quinn Williams
❑ Hillary Jessup, Chairman
❑ Haskell Monroe
❑J Ernie Wright
L,d NONE
Historic Preservation Committee
O Bill Lancaster
❑ Jane Hughey
❑ Neal Nutall, Jr.
Joint Relief Funding Review
Committee
❑ Margt}erite Anthony
❑ Meredith Waller
❑ Colleen Risinger
O Tedi Ellison 0 J. Kevin Byrne 0 Deborah Deitering
O Rusleen Maurice ❑ Reba Ragdale 0
NONE
❑ Jodi Warner, Chair
❑ Shawn Rhodes
❑/John Crompton
l� NONE
Parks and Recreation Board
❑ Kathleen Ireland
O Jody Ford
❑ Harry Green
Planning and Zoning
Commission
❑ John Nichols, Chair 0 Glenn Schroeder
❑ Marsha Sanford 0 Dennis Christiansen
O Harold Strong ["NONE
❑ Rick Heaney
O Alan King
❑ Susie Cox, alternate
❑ Jay Goss, Chair
O Denise Whisenant
liNONE
Design Review Board
❑ Hunter Goodwin
❑ Ward Wells
❑ Robert Rayburn, alternate
Zoning Board of Adjustments
O Joshua Benn
O Donald Braune
❑ Joan Perky
❑ Gary Thomas
❑ Gary ErvEin
❑ Derek Dietson
❑ Bill Davis
❑ Nancy Sawltelle
❑ John Nicholls
NONE
❑ John Richards
❑ Thomas Matlher
❑ Larry Hodges
❑ Glenn Brown, City Manager
❑ Sharon Colson, Chair
❑ Kenny Mallard
❑ Don Lewis
❑ Gregg Baird
❑ Chad Jones
El Stephen Syptak, Chair
❑ Tom Kirkland
El//NONE
❑ Hugh Lindsay, Area I
❑ John Crompton, Area II
❑ Steve Arden, Area III
❑ Hugh Stearns, Area IV
O Andrew Burleson, Student Resident
❑ Dorthea Robinson, Alternate,
ETJ Resident
O Chris Scotti, Councilmember
❑ Hillary Jessup, Historic
Preservation
❑ Lloyd Wasserman, County
Commission
Research Valley Partnership
Board of Directors
❑ rry Mariott
D NONE
Wolf Pen Creek TIF Board
❑ Marsha Sanford, Vice Chair
O James Massey
Outside Agency Funding Review
❑ Charles Taylor
0)Sheryl Welford
g NONE
Northgate Tax Increment
Finance Board
❑ David Scarmardo
O Glenn Thomas
Comprehensive Plan Committee
❑ John Richards, Area I
❑ Brian Bochner, Area I1
❑ Laurie Corbelli, Area III
❑ Jerry Cooper, Area IV
O Kristina Campbell, Alternate,
Student Resident
❑ Craig Hall, Resident -At -Large
El Lynn McIlhaney, Alternate,
Councilmember
❑ Gary Erwin, Parks & Rec
❑ Larry Haskins, Northgate
District Assoc.
O Chris Scotti, Councilman
❑ Marc Chaloupka
LWNONE
❑ Roger Reese
❑ Carolyn 1Berrow
❑ Anne Jackson
O Dale O'RRiley
❑ David Hart, Alternate, Area I
❑ Dennis Cotrington, Alternate, Area II
❑ Tom Taylor, Alternate, Area III
❑ Adrian Williams, Alternate, Area IV
❑ Douglas Rape', ETJ Resident
❑ Mike Guidc}, Alternate,
Resident -At -Large
❑ Bill Davis, ID&Z
❑ Kathleen Ireland, Parks & Rec
Alternate
❑ Bo Miles, Building & Land
Developmenit
❑ Larry Marriott, Home Builders
Assoc.
O Tedi Ellison, Intergovernmental
Comm/Chamber of Commerce
O James Massey, Intergovernmental
Comm/TAMU Admin
O Dr. Clark Ealy, Intergovernmental
Comm/CSISD
❑ Chuck Martinez,
Intergovernmental Comm/
Research Valley Patnership
O Linda LaSut, Intergovernmental
Comm/MPO
O Lindsey Guindi, Intergovernmental
Comm/Chamber of Commerce
O Rodney Weis, Intergovernmental
Comm/TAMU Transit
O Dr. Colleen Netterville,
Intergovernmental Comm/BISD
O Margie Lucas,
Intergovernmental Comm/
Brazos Transit District
❑ Chad Bohne, Intergovernmental
Comm/TxDOT
❑ Michael Parks, Intergovernmental
Comm%BVCOG
O Gary Arnold, Intergovernmental
Comm/Brazos County Sheriff
❑ Gary Teston, Intergovernmental
9mm/ Easterwood Airport
I/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
❑ Lynn Mcllhaney ❑ Ben White LY DONE
Brazos Valley Council of
-- // Governments
❑ Ron Silvia, Mayor E NONE
B/CS Metropolitan Planning
Organization
❑ Ron Silvia, Mayor "NONE
BVCOG TMPA Regional Park
Project Advisory Board
❑ Lynn Mcllhaney NONE
BVSWMA Policy Advisory
Board
❑ Ron Silvia, Mayor 0 Chris Scotti DV ONE
City Center Committee
❑ on Silvia ❑ Ben White ❑ Dave Ruesink
dNONE
Intergovernmental Committee
❑ iton Gay ❑ Ben White ❑ John Happ
[7' NONE
❑ pave Ruesink
R" NONE
❑ Dave Ruesink
❑ Ron Gay
❑ Ken Fogle
❑ Michael Parker, BVCOG
❑ Ron Gay
❑ John Nichols
❑ Joan Perry
Joint City/School
Intergovernmental Committee
❑ Ben White
Sister Cities Association
El/ NONE
Transportation Committee
❑ John Happ
❑ Linda LaSuit, MPO
❑ Bryan Woods, TxDOT
Wolf Pen Creek Oversight
Committee
❑ Chris Scotti
❑ Marsha Sanford
❑ Sharon Colson
O John kapp
❑ Lynn M4Ilhaney
O Dennis Christianson, TTI
(�IVONE
❑ Marc Chasloupka
❑ J di Warner
❑/NONE
Describe each affiliation or business relationship with an employee checked in Question 4above:
Adopted 01/13/06
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with local governmental 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 as necesi;ary
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
4
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 dr more?
Yes
No
D. Describe each affiliation or business relationship.
6.
A
/f/Cit- )141A)- /11k
Sign : of person to
business ess with the governmental entity
si p 7
Dte
Adopted 01/13/06