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Home My WebLink AboutACT Pipe & Supply2006/FEB/20/MON 11:49 AM ACT PIPE FAX No, 979 775 4255 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity P. 002 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 comntitts an offense if the person violates Section 176.006, Local Government Code. An offense under this section is aC1 s C misdemeanor. OFFICE USE ONLY Date Received I. Name of erson doing business with local governmeiitaTerittty. a,6g// •--57/71/7A4 xlerAv&- ifie,•34.4/ 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. ❑ Robert Alley, Fire Chief ❑ Steve Beachy, Parks & Rec ❑ Glenn Brown, City Manager ❑ Olivia Burnside, lnf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev El Don Fazzino, Legislative Liason ❑ Kim Foutz, Economic Dev El Connie Hooks, City Secretary ❑ Jeff Kersten, Finance S NONE ❑ Charles McLemore, Public Works ❑ Becky Nugent; Public Relations El Julie O'Connell, Human Resources El Mark Smith, Public Works ❑ Ed Spillane, Municipal. Judge O Cheryl Turney„ Purchasing Mgr. Describe each affiliation or business relationship with an employee checked in Question 3 above: 2006/FEB/20/MON 11:49 AM ACT PIPE FAX No, 979 775 4255 P. OC3 4. Describe each affiliation or business relationship with a person who is a localgovernment 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 ❑ Nancy Berry, Place 6 City of College Station Elected Officials College Station City Council ❑ Ben White; Place 1 ❑ Susan Lancaster, Place 4 NONE ❑ John. Happ; Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Eric Miller ❑ Lois Koontz ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Mary Lind Bryan 9 NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Don Scheri ❑ Jo Berg ' NONE ❑ Kevin Myers ❑ Joe Wallace ❑ Dan. B_ Sears, Chairman. ❑ George McLean, Vice Chair ❑ Frank Cox ❑ Mike Lane ❑ Larry D. Patton ❑ David Hart, alternate ❑ Steve Parker, alternate 0 David Rue sink, alternate [.. NONE ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev . NONE Facade Improvement Program Advisory Committee ❑ Valerian. Miranda, Architect ❑ Rick Lemmons,'Business Owner X Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator 2006/FEB/20/MON 11:50 AM ACT PIPE ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony LI Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice X1 NONE O Kathleen Ireland ❑ Carol Blaschke D John Crompton NONE . • LI Scott Shafer, Chairman ❑ Marsha Saufor'd El Harold Strong ❑ Rick Heany LI Alan King ❑ Susie Cox, alternate .0 Jay Goss, Chair ❑ Graham Sheffy ❑ DeniseWhiseuant FAX No, 979 775 4255 P. 004 Historic Preservation Committee ❑ Bill Lancaster LI David Ruesink ❑ Ernie Wright IX NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen NONE Design Review Board 'D Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Berm ❑ Donald Braune In Derek Dictson ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood ❑ Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer Ig NONE ❑ John Richards ❑ Charles Taylor Si NONE 2006/FEB/20/MON 11:50 AM ACT PIPE ❑ David Hickson ❑ Glenn Brown, City Manager FAX No. 979 775 4255 P. 005 Research Valley Partnership Board of Directors ❑ Larry Mariott ! NONE Wolf Pen Creek TIF Board ❑ Sharon Colson, Chair ❑ Marsha Sanford, Vice Chair ❑ Kenny Mallard ❑ James Massey ❑ Chris Scotti, Councilman ❑ Marc Chaloupka ig 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 ❑ Susan Lancaster ❑ Nancy Berry lei NONE Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayor 06 NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor [S NONE BVCOG TM/PA Regional Park Project Advisory Board ❑ Susan Lancaster 172f NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor ❑ Susan Lancaster NONE 2006/FEB/20/MON 11:50 AM ACT PIPE ❑ Ron Silvia 129. NONE ❑ Nancy Berry IX NONE ❑ Nancy Berry 0 NONE FAX No, 979 775 4255 P, 006 City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee LI Ben White LI .John Happ Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Ron Gay 1;gi NONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI 1A NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Describe each affiliation or business relationship with an employee checked in Question 4 above: 01 .7 Inst fle y ,bte6,:ve S a)ee7L /Hos /e7 /�64 I. At -7 -At -e o,x1 4/744,e,€4.7- !2e e0;4:_ , s ,4 ,Ql� r/(-rex_ Cif` 4— 4tyei/' f Adopted 01/13/06 Wolf Pen Creek Oversight Committee El Ron. Gay ❑ Chris Scotti X NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: 01 .7 Inst fle y ,bte6,:ve S a)ee7L /Hos /e7 /�64 I. At -7 -At -e o,x1 4/744,e,€4.7- !2e e0;4:_ , s ,4 ,Ql� r/(-rex_ Cif` 4— 4tyei/' f Adopted 01/13/06 2006/FEB/20/MON 11:50 AM ACT PIPE FAX No, 979 775 4255 P. 007 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 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? L I 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? r Yes No D. Describe each affiliation or business relationship. 6. Signature of rson doing business with the governmental entity ,az/0/ /off Date; Adopted 01/13/06