Tyler Uniform, Inc.CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with local governmental entity
FORM CIQ
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.
OFFICE USE ONLY
Date Received
1. Name of person doing business with local governmental entity.
I
'er-- vv % 0-v
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.
O Glenn Brown, City Manager
O Robert Alley, Fire Chief
O Pete Caler, Landfill Mgr.
O David Gwin, Economic Dev.
O David Massey, Electric
O Bob Cowell, Planning & Dev
O Cheryl Turney, Purchasing Mgr.
O Terry Childers, Deputy City Mgr
O Steve Beachy, Parks & Rec
O Harvey Cargill, City Attorney
O Connie Hooks, City Secretary
O Becky Nugent, Public Relations
O Mark Smith, Public Works
O John Woody, W/WW
O Kathy Merrill, Asst. City Mgr.
O Ben Roper, Inf. Tech.
❑ Michael Clancey, Police Chief
O Jeff Kersten, Chief Fin.Officer
❑ Julie O'Connell, Human Resources
O Ed Spillane, Municipal Judge
GONE
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.
❑ Ben White, Mayor
❑ Ron Gay, Place 3
O David Ruesink, Place 6
City of College Station Elected Officials
College Station City Council
❑ OPEN, Place 1
❑ Lynn Mcllhaney, Place 4
F NONE
❑ James Massey, Place 2
O Chris Scotti, Place 5
City of College Station Committees, Boards, and Commissions
O Larry Ringer, Chairman
O Mary Fran Troy
❑ Sonio Margarita Gangotena
O Sarah Adams, Chair
O James Batenhorst
O David Chester
❑ Donald Braune
❑ Dan B. Sears, Chairman
❑ Mike Lane
O Steve Parker, alternate
Ek1 ONE
B/CS Library Committee
O Katherine Edwards 0 Don Scherr
❑ Jeanne Mitchell ❑ B. Carroll Johnson
❑ James Bradford IBS II�ONE
Cemetery Committee
❑ Virginia Reese
❑ Weldon Kruger
❑ RC Slocum
E ONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
O Frank Cox
O Larry D. Patton
❑ Glenn Thomas, alternate
O Kevin Myers
❑ Joe Wallace
❑ James Matson
❑ David Hart
O Charles Thomas, alternate
O Quinn Williams
❑ Hillary Jessup, Chairman
❑ Haskell Monroe
❑ Ernie Wright
DONE
Historic Preservation Committee
❑ Bill Lancaster
❑ Jane Hughey
O Neal Nutall, Jr.
Joint Relief Funding Review
Committee
O Marguerite Anthony
❑ Meredith Waller
❑ Colleen Risinger
O Tedi Ellison 0 J. Kevin Byrne 0 Deborah Deitering
O Rusleen Maurice 0 Reba Ragdale 0
LONE
O Jodi Warner, Chair
O Shawn Rhodes
❑0JJoohn Crompton
Lt' 1�lONE
Parks and Recreation Board
O Kathleen Ireland
❑ Jody Ford
❑ Harry Green
Planning and Zoning
Commission
O John Nichols, Chair 0 Glenn Schroeder
❑ Marsha Sanford �❑ Dennis Christiansen E
O Harold Strong ONE
Design Review Board
❑ Joan Perry
O Gary Thomas
❑ Gary Erwin
O Derek Dictson
O Bill Davis
O Rick Heaney 0 Hunter Goodwin 0 Nancy Sawtelle
❑ Alan King 0 Ward Wells 0 John Nichols
❑ Susie Cox, alternate 0 Robert Rayburn, alternate DONE
O Jay Goss, Chair
O Denise Whisenant
i<ONE
Zoning Board of Adjustments
❑ Joshua Benn
❑ Donald Braune
❑ John Richards
❑ Thomas Mather
❑ Larry Hodges
❑ Glenn Brown, City Manager
❑ Sharon Colson, Chair
❑ Kenny Mallard
O Don Lewis
O Gregg Baird
O Chad Jones
O Stephen Syptak, Chair
O Tom Kirkland
1 --
ONE
O Hugh Lindsay, Area I
O 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
O Hillary Jessup, Historic
Preservation
O Lloyd Wasserman, County
Commission
Research Valley Partnership
Board of Directors
❑ Larry Mariott
El -ICI -ONE
Wolf Pen Creek TIF Board
O Marsha Sanford, Vice Chair
O James Massey
Outside Agency Funding Review
❑ Charles Taylor
❑ Sheryl Welford
GONE
Northgate Tax Increment
Finance Board
❑ David Scarmardo
O Glenn Thomas
Comprehensive Plan Committee
O John Richards, Area I
O Brian Bochner, Area II
O Laurie Corbelli, Area III
O Jerry Cooper, Area IV
O Kristina Campbell, Alternate,
Student Resident
❑ Craig Hall, Resident -At -Large
O Lynn Mcllhaney, Alternate,
Councilmember
O Gary Erwin, Parks & Rec
O Larry Haskins, Northgate
District Assoc.
O Chris Scotti, Councilman
❑ Marc Chaloupka
-ONE
❑ Roger Reese
❑ Carolyn Berrow
O Anne Jackson
O Dale O'Reiley
❑ David Hart, Alternate, Area I
O Dennis Corrington, Altemate, Area II
O Tom Taylor, Alternate, Area III
O Adrian Williams, Alternate, Area IV
O Douglas Rape', ETJ Resident
❑ Mike Guido, Alternate,
Resident -At -Large
O Bill Davis, P&Z
O Kathleen Ireland, Parks & Rec
Alternate
❑ Bo Miles, Building & Land
Development
❑ Larry Marriott, Home Builders
Assoc.
❑ Tedi Ellison, Intergovernmental
Comm/Chamber of Commerce
❑ James Massey, Intergovernmental
Comm/TAMU Admin
❑ Dr. Clark Ealy, Intergovernmental
Comm/CSISD
❑ Chuck Martinez,
Intergovernmental Comm/
Research Valley Patnership
❑ Linda LaSut, Intergovernmental
Comm/MPO
❑ 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
O Chad Bohne, Intergovernmental
Comm/TxDOT
O Michael Parks, Intergovernmental
Comm/BVCOG
O Gary Arnold, Intergovernmental
Comm/Brazos County Sheriff
❑ Gary Teston, Intergovernmental
Comm/ Easterwood Airport
L9'KIONE
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 CNONE
Brazos Valley Council of
Governments
❑ Mayor ONE
B/CS Metropolitan Planning
Organization
❑ Mayor/ONE
BVCOG TMPA Regional Park
Project Advisory Board
D Lynn Mcllhaney BNONE
BVSWMA Policy Advisory
Board
❑ Mayor ❑ Chris Scotti ®NONE
City Center Committee
❑ Ron Silvia 0 Ben White 0 Dave Ruesink
E NONE
Intergovernmental Committee
O Ron Gay 0 Ben White 0 John Happ
l;iiONE
❑ Dave Ruesink
C4ONE
Joint City/School
Intergovernmental Committee
0 Ben White 0 John Happ
Sister Cities Association
O Dave Ruesink HONE
Transportation Committee
❑ Ron Gay 0 John Happ 0 Lynn Mcllhaney
O Ken Fogle 0 Linda LaSuit, MPO 0 Dennis Christianson, TTI
O Michael Parker, BVCOG 0 Bryan Woods, TxDOT I21 ONE
❑ Ron Gay
O John Nichols
O Joan Perry
Wolf Pen Creek Oversight
Committee
O Chris Scotti
❑ Marsha Sanford
O Sharon Colson
❑ Marc Chaloupka
❑ Jodi Warner
®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
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.
6e
Signaturetdf person doing business with the governmental entity
7 -z -off
Date
Adopted 01/13/06