First Southwest CompanyCONFLICT 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 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
J Name of person doing business with local governmental entity.
First Southwest Company
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.)
J 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, other than through interactions related to First Southwest Company's ongoing role as financial
advisor to City of College Station and FSC Disclosure Services', a Division of First Southwest Company,
role in assisting City of College Station with continuing disclosure.
J Describe each affiliation or business relationshipwith aperson who is a localgovernment officer and who appoints or
employs a local government officer of the local governmental entity that is the subject of this questionnaire.
None, other than through interactions related to First Southwest Company's ongoing role as financial
advisor to City of College Station and FSC Disclosure Services', a Division of First Southwest Company,
role in assisting City of College Station with continuing disclosure.
Adopted 01/13/2006
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with local governmental entity
FORM CIQ
Page 2
J Name of local government officer with whom filer has affilitation or business relationship. (Complete this section only if the
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
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?
El 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.
Describe any other affiliation or business relationship that might cause a conflict of interest.
J
Firs LS thwest Company
By. 711441 7114 Ii 2t(�P
Signature of person doing business with the governmental entity Date
Adopted 01/13/2006