Loading...
HomeMy WebLinkAboutAmerican Cooling Tower, Inc.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. A Meri cin C c° tin JD , �.n� .?,0 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 fill September 1 of the year for which an activity described in Section 176.006(a), Local Gover not later than the 7th business day after the date the originally filed questionnaire becomes ng authority not later than nment Code, is pending and ncomplete 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 El Connie Hooks, City Secretary ❑ Jeff Kersten, Finance NONE ❑ Cha ❑ Bed ❑ Julie ❑ Mar ❑ Ed ❑ Che] les McLemore, Public Works y Nugent, Public Relations O'Connell, Human Resources Smith, Public Works pillane, Municipal Judge yl Turney, Purchasing Mgr. Describe each affiliation or business relationship with an employee checked in Ques ion 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 I O Susan Lancaster, Place 4 NONE ❑ John Happ, Place 2 ❑ ChI•is 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 ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev NONE B/CS Library Committee ❑ Katherine Edwards 0 Doti Scherr ❑ Jeanne Mitchell 0 Jo lerg ❑ James Bradford V NONE Cemetery Committee ❑ Virginia Reese ❑ Mary Lind Bryan *NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ George McLean, Vice Chair ❑ Larry D. Patton ❑ David Ruesink, alternate Facade Improvement Program Advisory Committee ❑ Valerian Miranda, Architect O Robert Mosley, City Engineer ❑ Kevin Myers ❑ Joe Wallace ❑ Fr Cox ❑ Dav d Hart, alternate NONE O Rick Lemmons, Business Owner O Eric Barton, CD Coordinator ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice NONE ❑ Kathleen Ireland O Carol Blaschke ❑ John Crompton 113- NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany O Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright 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 j NONE Design Review Board O Hunter Goodwin ❑ Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Derek Dictson ❑ Malrsha Crenwelge ❑ Di ankar Sen ❑ Ne 1 Nutall, Jr. O Maiy Sherwood O Peggy Samson ❑ Jodl Warner ❑ Gary Thomas ❑ Ga ry Erwin O Ken Reynolds O Bill avis ❑ Nano), Sawtelle ❑ Scot Shafer .NONE ❑ John Richards ❑ Charles Taylor NON O David Hickson O Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard Research Valley Partnership Board of Directors ❑ Larry Marion NONE Wolf Pen Creek TIF Board ❑ Ch is Scotti, Councilman O Marsha Sanford, Vice Chair ❑ Ma -c Chaloupka O James Massey 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. ❑ Susan Lancaster ❑ Ron Silvia, Mayor ❑ Ron Silvia, Mayor ❑ Susan Lancaster ❑ Ron Silvia, Mayor Brazos County Health Department ❑ Nancy Berry Xi NONE Brazos Valley Council of Governments Board of Directors NONE B/CS Metropolitan Planning Organization `INONE BVCOG TMPA Regional Park Project Advisory Board y NONE BVSWMA Policy Advisory Board O Susan Lancaster NONE ❑ Ron Silvia NONE Q Nancy Berry -434 NONE ❑ Nancy Berry NONE City Center Committee O Ben White 0 Nahcy Berry Intergovernmental Committee O Ben White ❑ Jo Happ Joint City/School Intergovernmental Committee O Ben White 0 Joh Happ Sister Cities Association O Ron Gay ,f1 NONE O Ron Gay O Linda LaSuit, MPO O Bryan Woods, TxDOT Transportation Committee O John Happ ❑ Dennis Christianson, TTI NONE ❑ Ken Fogle ❑ Miciael Parker, BVCOG Adopted 01/13/06 Wolf Pen Creek Oversight Committee III NONE ■ Ron Gay ■ Chris Scotti Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01/13/06 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 busines 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 receiie taxable income from the filer of the questionnaire? Yes No B. Is the filer of the questionnaire receiving or likely to receive taxable income froth 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 C�7 No C. Is the filer of this questionnaire affiliated with a corporation or other business en ity that the local government officer serves as an officer or director, or holds an ownership of 10 per ent or more? Yes No D. Describe each affiliation or business relationship. 6. Signature of person doing business with the governmental entity Date Adopted 01/13/06