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All Play, Inc.CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ 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 commits 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 ,11 Name of person doing business with local governmental entity. All Play, Inc. . E . filing authority not later than Code, is pending and incomplete or inaccurate.) ECheck 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 September 1 of the year for which an activity described in Section 176.006(a), Local Government not later than the 7th business day after the date the originally filed questionnaire becomes .31 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. None -11 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 governmental entity that is the subject of this questionnaire. None Amandid 01/1312006 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ Page 2 !I Name of local government officer with whom filer has affiliation or business relationship. (Complete this section only if answer to A, B, or C is YES.) This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or business relationship. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? Yes X 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 X No D. Describe each affiliation or business relationship. N/A Describe any other affiliation or business relationship that might cause a conflict of interest. 7 Kurt Futrell, President February 18, 2009 nature of person doing business with the governmental entity Date Amended 01113/2008 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. PlayPower LT Farmington, Inc. c/o All Play, Inc. 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 Robert Alley, Fire Chief O Steve Beachy, Parks & Rec O Glenn Brown, City Manager O 1 livia Burnside, Inf. Tech. O Pete Cater, Landfill Mgr. El e arvey Cargill, City Attorney • NPNE El Michael Clancey, Police Chief O Lance Simms, Planning & Dev O John Woody, W/WW O Terry Childers, Deputy City Mgr El Connie e ooks, City Secretary O Jeff Kersten, Chief Fin.! fficer El 0 Becky Nugent, Public Relations El Julie 0'&Rnnell, Human Resources El Mark Smith, Public Works El Ed Spillane, Municipal Judge CI Cheryl Turney, Purchasing Mgr. 0 David Massey, Electric Describe each affiliation or business relationship with an employee checked in n uestion 3 above: N/A 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 O Lynn McIlhaney, Place 4 El NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Mary Fran Troy O Jennifer Bohac O Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Donald Braune ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate ® NONE B/CS Library Committee O 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 ® NONF El Kevin Myers El Joe Wallace ❑ James Matson ❑ David Hart El Charles Thomas, alternate O Quinn Williams O Hillary Jessup, Chairman O Haskell Monroe O Ernie Wright E NONE O Rebecca Eplen O Rusleen Maurice E NONE O Jodi Warner, Chair O Shawn Rhodes O John Crompton 1E NONE 0 John Nichols, Chair O Marsha Sanford O Harold Strong O Rick Heany O Alan King O Susie Cox, alternate O Jay Goss, Chair O Denise Whisenant gl NONE Historic Preservation Committee O Bill Lancaster El Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee 0 J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board O Kathleen Ireland O Jody Ford O Harry Green Planning and Zoning Commission O Glenn Schroeder O Dennis Christiansen El NONE Design Review Board O Hunter Goodwin El Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments El Joshua Benn O Donald Braune 0 Marguerite Anthony O Meredith Waller O Colleen Risinger El Deborah Deitering 0 Peggy Samson O Joan Perry O Gary Thomas 0 Gary Erwin El Derek Dictson El Bill Davis 0 Nancy Sawtelle LI John Nichols IM NONE 0 John Richards 0 Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird ❑ Chad Jones ❑ Stephen Syptak, Chair ❑ Tom Kirkland [I NONE Cl 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, Historic Preservation ❑ Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors ❑ Larry Mariott ® NONE Wolf Pen Creek TIF Board ❑ Marsha Sanford, Vice Chair O James Massey Outside Agency Funding Review ❑ Charles Taylor ❑ Sheryl Welford ® NONE Northgate Tax Increment Finance Board ❑ David Scarmardo ❑ Glenn Thomas Comprehensive Plan Committee ❑ John Richards, Area I ❑ Brian Bochner, Area II ❑ Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ Kristina Campbell, Alternate, Student Resident ❑ Craig Hall, ResidentJAtJLarge ❑ Lynn Mcllhaney, Alternate, Councilmember ❑ Gary Erwin, Parks & Rec ❑ Larry Haskins, Northgate District Assoc. ❑ Chris Scotti, Councilman ❑ Marc Chaloupka Il NONE ❑ Roger Reese ❑ Carolyn Berrow ❑ Anne Jackson ❑ D1O'RI�y ❑ David Hart, Alternate, Area I ❑ Dennis Corrington, Alternate, Area H ❑ Tom Taylor, Alternate, Area III ❑ Adrian Williams, Alternate, Area IV ❑ DRu ithAng Ft, ETJ RFOCtpW ❑ Mike Guido, Alternate, ResidentJAtJLarge Cl Bill Davis, P&Z ❑ 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 ❑ Dr. Colleen Netterville, Intergovernmental Comm/BISD O Margie Lucas, Intergovernmental Comm/ Brazos Transit District ❑ Chad Bohm, Intergovernmental Comm/TxDOT ❑ Michael Parks, Intergovernmental CommBVCOG O Gary Arnold, Intergovernmental Comm/Brazos County Sheriff ❑ Gary Teston, Intergovernmental Comm/ Easterwood Airport ® 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. 0 Lynn Mcllhaney 0 Ron Silvia, Mayor LI Ron Silvia, Mayor Li Lynn Mcllhaney Li Ron Silvia, Mayor 0 Ron Silvia 3 NONE 0 Ron Gay 13 NONE Brazos County Health Department 0 Ben White EX NONE Brazos Valley Council of Governments IX NONE B/CS Metropolitan Planning Organization NONE BVCOG TMPA Regional Park Project Advisory Board [X NONE BVSWMA Policy Advisory Board D Chris Scotti City Center Committee O Ben White Intergovernmental Committee O Ben White 1211 NONE 0 Dave Ruesink D John Happ O Dave Ruesink 3 NONE Joint City/School Intergovernmental Committee O Ben White 0 John Happ Sister Cities Association O Dave Ruesink IX NONE O Ron Gay O Ken Fogle O Michael Parker, BVCOG O Ron Gay Transportation Committee O John Happ O Linda LaSuit, MPO O Bryan Woods, TxDOT Wolf Pen Creek Oversight Committed O Chris Scotti O Lynn Mcllhaney O Dennis Christianson, TTI 1E NONE NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: N/A 4 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. N/A A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? Yes X 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 x No D. Describe each affiliation or business relationship. N/A 6. Kurt Futrell, December 6, 2006 Principal Agent Signature of person doing business with the governmental entity Date Adopted 01/13/06