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HomeMy WebLinkAboutFuqua ConstructionCONFLICT OF INTEREST QUESTIONNAIRE 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 misdemea or. FORM CIQ OFFICE USE ONLY Date Received 1. Name of person doing business with local governmental entity. 2. LE._.(2i_QIi\A__ Et) 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, Inf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev ❑ Don Fazzino, Legislative Liason ❑ Charles Wood, Economic Dev ❑ Connie Hooks, City Secretary 0 Jeff Kersten, Finance rAtIONE 0 Charles McLemore, Public Works ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. 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. ❑ 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 ❑ John Happ, Place 2 ❑ Susan Lancaster, Place 4 ❑ Chris Scotti, Place 5 C7 -NONE City of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ Larry Ringer, Chairman ❑ Katherine Edwards ❑ Don Scherr ❑ Eric Miller 0 Jeanne Mitchell ❑ Jo Berg ❑ Lois Koontz ❑ James Bradford 171 --NONE Cemetery Committee ❑ Sarah Adams, Chair ❑ Virginia Reese ❑ James Batenhorst ❑ Mary Lind Bryan ❑ David Chester INTONE ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev 4.3<IONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Kevin Myers ❑ Joe Wallace ❑ George McLean, Vice Chair ❑ Frank Cox ❑ Larry D. Patton ❑ David Hart, alternate ❑ David Ruesink, alternate C'TONE Facade Improvement Program Advisory Committee ❑ Valerian Miranda, Architect ❑ Rick Lemmons, Business Owner ❑ Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ RRuuen Maurice ON E ❑ Kathleen Ireland ❑ Carol Blaschke ❑ Jo -Crompton NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernieright l ONE 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 ❑ Den ' ristiansen ONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ 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.8fiaf r ONE ❑ John Richards ❑ C es Taylor NONE Research Valley Partnership Board of Directors ❑ David Hickson ❑ Larry Mariott ❑ Glenn Brown, City Manager gl.Nt5NE ❑ Sharon Colson, Chair ❑ Kenny Mallard Wolf Pen Creek TIF Board ❑ Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair ❑ Marc CYra'loupka ❑ James Massey ONE 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. ❑ Susan Lancaster Brazos County Health Department ❑ Nancy Berry Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayor ONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor ef2r&ONE BVCOG TMPA Regional Park Project Advisory Board ❑ Susan Lancaster tl-K6NE BVSWMA Policy Advisory Board ONE 0 Ron Silvia, Mayor 0 Susan Lancaster ONE ❑ Ron S' a ONE ❑ Nancy Berry ® 1ONE ❑ Nancy! Berry • TONE City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee ❑ Ben White ❑ John Happ Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister'Cities Association ❑ Ron Gay FJ'NONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI 111 ONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Wolf Pen Creek Oversight Committee ❑ Ron Gay O Chris Scotti O 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 or each officer with whom the filer has affiliation or other relationship. Attach additional pages to this Form IQ 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 likeli 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 i ome from or at the direction of the local government officer named in this section AND the taxable income i. not from the local governmental entity? Yes No C. Is the filer of this questionnaire affiliated with a corporation or other b siness 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. Sigyfature of rson gybing bu ness with the governmental entity /7/06.,/ (727, 2c/v Date Adopted 01/13/06 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 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. 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, Inf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ NONE ❑ Michael Clancey, Police Chief ❑ Lance Simms, Planning & Dev ❑ John Woody, W/WW ❑ Terry Childers, Deputy City Mgr ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Chief Fin.Officer ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. ❑ David Massey, Electric Describe each affiliation or business relationship with an employee checked in Question 3 above: NIS 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 O Ron Gay, Place 3 ❑ David Ruesink, Place 6 City of College Station Elected Officials College Station City Council ❑ Ben White, Place 1 ❑ Lynn Mcllhaney, Place 4 ❑ NONE O John Happ, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman ❑ Mary Fran Troy ❑ Jennifer Bohac ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester 0 Donald Braune ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate O NONE B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Weldon Kruger El 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 ❑ NONE ❑ Kevin Myers ❑ Joe Wallace ❑ James Matson ❑ David Hart ❑ Charles Thomas, alternate ❑ Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright ❑ NONE ❑ Rebecca Eplen ❑ Rusleen Maurice ❑ NONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton ❑ NONE ❑ John Nichols, Chair ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King O Susie Cox, alternate ❑ Jay Goss, Chair ❑ Denise Whisenant O NONE Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey ❑ Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulee Parks and Recreation Board ❑ Kathleen Ireland ❑ Jody Ford ❑ Harry Green Planning and Zoning Commission ❑ Glenn Schroeder ❑ Dennis Christiansen ❑ NONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Marguerite Anthony ❑ Meredith Waller O Colleen Risinger ❑ Deborah Deitering ❑ Peggy Samson ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin ❑ Derek Dictson ❑ Bill Davis O Nancy Sawtelle ❑ John Nichols ❑ NONE ❑ John Richards ❑ Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird ❑ Chad Jones ❑ Stephen Syptak, Chair ❑ Tom Kirkland ❑ NONE ❑ 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 ❑ 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 Cl Laurie Corbelli, Area Ill ❑ Jerry Cooper, Area IV ❑ Kristina Campbell, Alternate, Student Resident ❑ Craig Hall, Resident -At -Large ❑ Lynn McIlhaney, Alternate, Councilmember ❑ Gary Erwin, Parks & Rec ❑ Larry Haskins, Northgate District Assoc. ❑ Chris Scotti, Councilman ❑ Marc Chaloupka ❑ NONE ❑ Roger Reese ❑ Carolyn Berrow ❑ Anne Jackson ❑ Dale O'Riley ❑ David Hart, Alternate, Area I ❑ Dennis Corrington, Alternate, Area II ❑ Tom Taylor, Alternate, Area III ❑ Adrian Williams, Alternate, Area IV ❑ Douglas Rape', ETJ Resident ❑ Mike Guido, Alternate, Resident -At -Large ❑ 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 ❑ Rodney Weis, Intergovernmental Comm/TAMU Transit ❑ Dr. Colleen Netterville, Intergovernmental Comm/B1SD ❑ Margie Lucas, Intergovernmental Comm/ Brazos Transit District ❑ Chad Bohne, Intergovernmental Comm/TxDOT ❑ Michael Parks, Intergovernmental Comm/BVCOG ❑ 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. ❑ Lynn Mcllhaney ❑ Ron Silvia, Mayor ❑ Ron Silvia, Mayor ❑ Lynn Mcllhaney ❑ Ron Silvia, Mayor ❑ Ron Silvia ❑ NONE ❑ Ron Gay ❑ NONE Brazos County Health Department ❑ Ben White ❑ NONE Brazos Valley Council of Governments ❑ NONE B/CS Metropolitan Planning Organization ❑ NONE BVCOG TMPA Regional Park Project Advisory Board ❑ NONE BVSWMA Policy Advisory Board ❑ Chris Scotti City Center Committee ❑ Ben White Intergovernmental Committee ❑ Ben White ❑ NONE ❑ Dave Ruesink ❑ John Happ ❑ Dave Ruesink ❑ NONE Joint City/School Intergovernmental Committee El Ben White ❑ John Happ Sister Cities Association ❑ Dave Ruesink ❑ NONE ❑ Ron Gay ❑ Ken Fogle ❑ Michael Parker, BVCOG El Ron Gay Transportation Committee ❑ John Happ ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee 0 Chris Scotti ❑ Lynn Mcllhaney ❑ Dennis Christianson, TTI ❑ NONE ❑ NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: OR Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE 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 off has affiliation or other relationship. Attach additional pages to this Form CIQ as nec 5. Name of local government officer with whom filer has affiliation or business this section only if the answer to A, B, or C is YES. FORM CIQ icer with whom the filer essary. relationship. (Complete 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. Signature of person doing btness with the governmental entity Date Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE 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. FORM CIQ OFFICE USE ONLY Date Received 1. Name of person doing business with local governmental entity. 2. HA_ 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, Inf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ NONE O Michael Clancey, Police Chief ❑ Lance Simms, Planning & Dev ❑ John Woody, W/WW O Terry Childers, Deputy City Mgr ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Chief Fin.Officer ❑ Becky Nugent, Public Relations O Julie O'Connell, Human Resources ❑ Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge O Cheryl Turney, Purchasing Mgr. ❑ David Massey, Electric Describe each affiliation or business relationship with an employee checked in Question 3 above: NIS 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 ❑ Lynn Mcllhaney, Place 4 ❑ NONE ❑ John Happ, Place 2 ❑ Chris Scotti. Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Mary Fran Troy ❑ Jennifer Bohac ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Donald Braune ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate ❑ NONE B/CS Library Committee ❑ 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 ❑ NONE ❑ Kevin Myers ❑ Joe Wallace ❑ James Matson ❑ David Hart ❑ Charles Thomas, alternate ❑ Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright ❑ NONE ❑ Rebecca Eplen ❑ Rusleen Maurice ❑ NONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton ❑ NONE ❑ John Nichols, Chair ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair O Denise Whisenant O NONE Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey ❑ Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulee Parks and Recreation Board ❑ Kathleen Ireland O Jody Ford O Harry Green Planning and Zoning Commission ❑ Glenn Schroeder ❑ Dennis Christiansen O NONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Marguerite Anthony ❑ Meredith Waller ❑ Colleen Risinger ❑ Deborah Deitering O Peggy Samson ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin O Derek Dictson ❑ Bill Davis ❑ Nancy Sawtelle ❑ John Nichols O NONE ❑ John Richards O Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird ❑ Chad Jones ❑ Stephen Syptak, Chair ❑ Tom Kirkland ❑ NONE ❑ 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 O Marsha Sanford, Vice Chair ❑ James Massey Outside Agency Funding Review ❑ Charles Taylor ❑ Sheryl Welford ❑ NONE Northgate Tax Increment Finance Board ❑ David Scarmardo ❑ Glenn Thomas Comprehensive Plan Committee O John Richards, Area I ❑ Brian Bochner, Area II ❑ Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ Kristina Campbell, Alternate, Student Resident ❑ Craig Hall, Resident -At -Large ❑ Lynn McIlhaney, Alternate, Councilmember O Gary Erwin, Parks & Rec ❑ Larry Haskins, Northgate District Assoc. O Chris Scotti, Councilman ❑ Marc Chaloupka O NONE ❑ Roger Reese ❑ Carolyn Berrow ❑ Anne Jackson ❑ Dale O'Riley ❑ David Hart, Alternate, Area I ❑ Dennis Corrington, Alternate, Area II ❑ Tom Taylor, Alternate, Area III ❑ Adrian Williams, Alternate, Area IV ❑ Douglas Rape', ETJ Resident ❑ Mike Guido, Alternate, Resident -At -Large ❑ 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 O James Massey, Intergovernmental Comm/TAMU Admin O 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 ❑ Rodney Weis, Intergovernmental Comm/TAMU Transit ❑ Dr. Colleen Netterville, Intergovernmental Comm/BISD ❑ Margie Lucas, Intergovernmental Comm/ Brazos Transit District ❑ Chad Bohne, Intergovernmental Comm/TxDOT ❑ Michael Parks, Intergovernmental Comm/BVCOG ❑ 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. ❑ Lynn Mcllhaney ❑ Ron Silvia, Mayor ❑ Ron Silvia, Mayor ❑ Lynn Mcllhaney ❑ Ron Silvia, Mayor ❑ Ron Silvia ❑ NONE ❑ Ron Gay ❑ NONE Brazos County Health Department ❑ Ben White ❑ NONE Brazos Valley Council of Governments ❑ NONE B/CS Metropolitan Planning Organization ❑ NONE BVCOG TMPA Regional Park Project Advisory Board ❑ NONE BVSWMA Policy Advisory Board ❑ Chris Scotti City Center Committee ❑ Ben White Intergovernmental Committee ❑ Ben White ❑ NONE ❑ Dave Ruesink ❑ John Happ ❑ Dave Ruesink ❑ NONE Joint City/School Intergovernmental Committee ❑ Ben White 0 John Happ Sister Cities Association ❑ Dave Ruesink ❑ NONE ❑ Ron Gay ❑ Ken Fogle ❑ Michael Parker, BVCOG 0 Ron Gay Transportation Committee ❑ John Happ ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee ❑ Chris Scotti ❑ Lynn Mcllhaney ❑ Dennis Christianson, TTI ❑ NONE ❑ NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: t\J ) 6 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 tiler 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. y\i1P- Signature of person doing mess with the governmental entity sa-6-off Date Adopted 01/13/06 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. 1. Name of person doing business with local governmental entity. 2. OFFICE USE ONLY Date Received “, ti MAR 08 2006 City of College Station 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. 0 Robert Alley, Fire Chief O Steve Beachy, Parks & Rec ID Glenn Brown, City Manager 0 Olivia Burnside, Inf. Tech. O Pete Caler, Landfill Mgr. 0 Harvey Cargill, City Attorney O John Woody, Utilities O Michael Clancey, Police Chief O Joey Dunn, Planning & Dev O Don Fazzino, Legislative Liason O Kim Foutz, Economic Dev O Connie Hooks, City Secretary O Jeff Kersten, Finance 0 NONE O Charles McLemore, Public Works LI Becky Nugent, Public Relations O Julie O'Connell, Human Resources LI Mark Smith, Public Works LI Ed Spillane, Municipal Judge O Cheryl Turney, Purchasing Mgr. Describe each affiliation or business relati nship 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. O Ron Silvia, Mayor O Ron Gay, Place 3 O Nancy Berry, Place 6 City of College Station Elected Officials College Station City Council 0 Ben White, Place 1 0 John Happ, Place 2 O Susan Lancaster, Place 4 0 Chris Scotti, Place 5 O NONE City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman O Eric Miller O Lois Koontz O Sarah Adams, Chair O James Batenhorst O David Chester 0 Dan B. Sears, Chairman O Mike Lane O Steve Parker, alternate O Karen Kasper, Merchant 0 Joey Dunn, Dir. Planning & Dev 0 NONE B/CS Library Committee 0 Katherine Edwards 0 Jeanne Mitchell O James Bradford Cemetery Committee 0 Virginia Reese O Mary Lind Bryan O NONE Construction Board of Adjustments and Appeals/Building & Standards Commission O George McLean, Vice Chair O Larry D. Patton 0 David Ruesink, alternate Facade Improvement Program Advisory Committee O Don Scherr 0 Jo Berg Cl NONE O Kevin Myers O Joe Wallace O Frank Cox O David Hart, alternate O NONE O Valerian Miranda, Architect 0 Rick Lemmons, Business Owner O Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator O Hillary Jessup, Chairman EJ Marguerite Anthony O Thomas Taylor El Colleen Risinger O Rebecca Eplen O Rusleen Maurice O NONE O Kathleen Ireland O Carol Blaschke O John Crompton 0 NONE 0 Scott Shafer, Chairman O Marsha Sanford O Harold Strong O Rick Heany O Alan King O Susie Cox, alternate El Jay Goss, Chair 0 Graham Sheffy El Denise Whisenant Historic Preservation Committee El Bill Lancaster O David Ruesink O Ernie Wright 0 NONE Joint Relief Funding Review Committee O J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board O Glenn Schroeder 0 Jeannie McCandless O Harry Green Planning and Zoning Commission O John Nichols 0 Dennis Christiansen El NONE Design Review Board O Hunter Goodwin O Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments O Joshua Benn 0 Donald Braune O Derek Dictson O Marsha Crenwelge O Dipankar Sen O Neal Nutall, Jr. O Mary Sherwood O Peggy Samson O Jodi Warner O Gary Thomas O Gary Erwin O Ken Reynolds El Bill Davis O Nancy Sawtelle O Scott Shafer O NONE O John Richards 0 Charles Taylor O NONE O David Hickson O Glenn Brown, City Manager O Sharon Colson, Chair O Kenny Mallard Research Valley Partnership Board of Directors O Larry Mariott CI NONE Wolf Pen Creek TIF Board O Marsha Sanford, Vice Chair O James Massey O Chris Scotti, Councilman O Marc Chaloupka O 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. CI Susan Lancaster O Ron Silvia, Mayor O Ron Silvia, Mayor O Susan Lancaster El Ron Silvia, Mayor Brazos County Health Department CI Nancy Berry 0 NONE Brazos Valley Council of Governments Board of Directors 0 NONE B/CS Metropolitan Planning Organization El NONE BVCOG TMPA Regional Park Project Advisory Board O NONE BVSWMA Policy Advisory Board CI Susan Lancaster 0 NONE LI Ron Silvia Ell NONE 0 Nancy Berry O NONE O Nancy Berry 0 NONE City Center Committee 0 Ben White 0 Nancy Berry Intergovernmental Committee 0 Ben White 0 John l-lapp Joint City/School Intergovernmental Committee O Ben White 0 John Happ Sister Cities Association O Ron Gay 0 NONE O Ron Gay 0 Linda LaSuit, MPO O Bryan Woods, TxDOT Transportation Committee 0 John Happ 0 Dennis Christianson, TTI 0 NONE O Ken Fogle O Michael Parker, BVCOG Wolf Pen Creek Oversight Committee El Ron Gay O Chris Scotti O 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. Signature of person doi g business with the governmental entity a -b77 -4p. Date Adopted 01/13/06