HDR EngineeringCity of College Station
CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor or other person doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code
by a person who has a business relationship as defined by Section 176.001(1-a) with a local
governmental entity and the person meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local governmental
entity 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 knowingly violates Section 176.006, Local
Government Code. An offense under this section is a Class C misdemeanor.
OFFICE USE ONLY
Date Received
El Name of person who has a business relationship with local governmental entity.
HDR Engineering, Inc.
filing authority not
incomplete or inaccurate.)
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
later than the 7th business day after the date the originally filed questionnaire becomes
1 Name of local government officer with whom filer has employment or business relationship.
No known employment or business relationships.
with whom the filer has an
Code. Attach additional
other than investment
income, from or at the
not received from the local
respect to which the local
in this section.
Name of Officer
This section (item 3 including subparts A, B, C & D) must be completed for each officer
employment or other business relationship as defined by Section 176.001(1-a), Local Government
pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income,
income, from the filer of the questionnaire?
Yes No
B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment
direction of the local government officer named in this section AND the taxable income is
governmental entity?
Yes No
C. Is the filer of this questionnaire employed by a corporation or other business entity with
government officer serves as an officer or director, or holds an ownership of 10 percent or more?
Yes No
D. Describe each employment or business relationship with the local government officer named
r ,
Ramon F. Miguez, PE 02/20/2014
Signature of perJonoing business with the governmental entity Date
Adopted 06/29/2007