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HomeMy WebLinkAboutBrazos Valley ServicesCONFLICT 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. 1. Name of person doing bus ess with local governmental entity. 2. FORM CIQ OFFICE USE ONLY Date Received PiCheck 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. O Glenn Brown, City Manager O Robert Alley, Fire Chief O Pete Caler, Landfill Mgr. O David Gwin, Economic Dev. O David Massey, Electric O Bob Cowell, Planning & Dev O Cheryl Turney, Purchasing Mgr. O Terry Childers, Deputy City Mgr O Steve Beachy, Parks & Rec O Harvey Cargill, City Attorney O Connie Hooks, City Secretary O Becky Nugent, Public Relations O Mark Smith, Public Works O Dave Coleman, W/WW O Kathy Merrill, Asst. City Mgr. O Ben Roper, Inf. Tech. O Michael Clancey, Police Chief O Jeff Kersten, Chief Fin.Officer O Julie O'Connell, Human Resources Spillane, Municipal Judge NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE FORM CIQ 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. ❑ Ben White, Mayor ❑ Ron Gay, Place 3 O David Ruesink, Place 6 City of College Station Elected Officials College Station City Council O John Compton, Place 1 O Lynn Mcllhaney, Place 4 ATONE O James Massey, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions B/CS Library Committee O Katherine Edwards ❑ Larry Ringer, Chairman ❑ Mary Fran Troy O Sonio Margarita Gangotena ❑ Sarah Adams, Chair ❑ James Batenhorst O David Chester O Donald Braune ❑ Dan B. Sears, Chairman ❑ Mike Lane O Steve Parker, alternate NONE O Jeanne Mitchell O James Bradford Cemetery Committee O Virginia Reese O Weldon Kruger O RC Slocum "SNONE Construction Board of Adjustments and Appeals/Building & Standards Commission O Frank Cox O Larry D. Patton O Glenn Thomas, alternate O Don Scherr ❑ B. Carroll Johnson NONE ❑ Kevin Myers O Joe Wallace O James Matson O David Hart O Charles Thomas, alternate O Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright NONE Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey ❑ Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ Marguerite Anthony ❑ Meredith Waller O Colleen Risinger ❑ Tedi Ellison ❑ J. Kevin Byrne ❑ Deborah Deitering \ ❑ Rusleen Maurice ❑ Reba Ragdale ❑ j�❑ NONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton rONE ❑ John Nichols, Chair ❑ Marsha Sanford ❑ Harold Strong Parks and Recreation Board ❑ Kathleen Ireland ❑ Jody Ford ❑ Harry Green Planning and Zoning Commission ❑ Glenn Schroeder ❑ Dennis Christiansen NK NONE Design Review Board ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin ❑ Derek Dictson O Bill Davis ❑ Rick Heaney 0 Hunter Goodwin ❑ Nancy Sawtelle ❑ Alan King ❑ Ward Wells 0 John Nichols ❑ Susie Cox, alternate ❑ Robert Rayburn, alternate 16 NONE ❑ Jay Goss, Chair ❑ Denise Whisenant NONE Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ 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 ❑ arry Mariott NONE Wolf Pen Creek TIF Board ❑ Marsha Sanford, Vice Chair ❑ James Massey Outside Agency Funding Review El Charles Taylor ❑ Sheryl Welford NONE Northgate Tax Increment Finance Board ❑ David Scarmardo O Glenn Thomas Comprehensive Plan Committee ❑ John Richards, Area I ❑ Brian Bochner, Area II ❑ Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ Kristina Campbell, Alternate, Student Resident O Craig Hall, Resident -At -Large ❑ Lynn Mcllhaney, Alternate, Councilmember ❑ Gary Erwin, Parks & Rec ❑ Chris Scotti, Councilman ❑ Marc Chaloupka NONE ❑ Roger Reese ❑ Carolyn Berrow ❑ Anne Jackson ❑ Dale O'Reiley ❑ David Hart, Alternate, Area I ❑ Dennis Corrington, Alternate, Area 11 ❑ 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 ❑ Larry Haskins, Northgate 0 Bo Miles, Building & Land District Assoc. 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 O Linda LaSut, Intergovernmental Comm/MPO O Lindsey Guindi, Intergovernmental Comm/Chamber of Commerce O Rodney Weis, Intergovernmental Comm/TAMU Transit O Dr. Colleen Netterville, Intergovernmental Comm/BISD O Margie Lucas, Intergovernmental Comm/ Brazos Transit District O Chad Bohne, Intergovernmental Comm/TxDOT O Michael Parks, Intergovernmental Comm/BVCOG ❑ Gary Arnold, Intergovernmental Comm/Brazos County Sheriff O Gary Teston, Intergovernmental omm/ 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. O Lynn Mcllhaney O Mayor O Mayor O Lynn Mcllhaney O Mayor O Ron Silvia kNONE O Ron Gay kNONE Brazos County Health Department 0 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 O Chris Scotti City Center Committee O Ben White Intergovernmental Committee O Ben White NONE 0 Dave Ruesink 0 John Happ O Dave Ruesink O NONE O Dave Ruesink O Ron Gay O Ken Fogle O Michael Parker, BVCOG O Ron Gay O John Nichols O Joan Perry Joint City/School Intergovernmental Committee O Ben White Sister Cities Association NONE Transportation Committee O John Happ O Linda LaSuit, MPO O Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee O Chris Scotti O Marsha Sanford O Sharon Colson O John Happ O Lynn Mcllhaney O Dennis Christianson, TTI NONE O Marc Chaloupka O Jodi Warner NONE 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 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 doing business with the governmental entity Adopted 01/13/06 CERTIFICATION 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. C 4 if S 2. c ps...�► t�� Se -,4 res 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. ❑ Glenn Brown, City Manager ❑ Robert Alley, Fire Chief ❑ Pete Caler, Landfill Mgr. O David Gwin, Economic Dev. O David Massey, Electric ❑ Bob Cowell, Planning & Dev ❑ Cheryl Turney, Purchasing Mgr. ❑ Terry Childers, Deputy City Mgr O Steve Beachy, Parks & Rec ❑ Harvey Cargill, City Attorney O Connie Hooks, City Secretary ❑ Becky Nugent, Public Relations ❑ Mark Smith, Public Works ❑ John Woody, W/WW ❑ Kathy Merrill, Asst. City Mgr. ❑ Ben Roper, Inf. Tech. ❑ Michael Clancey, Police Chief ❑ Jeff Kersten, Chief Fin.Officer ❑ Julie O'Connell, Human Resources ❑ Ed Spillane, Municipal Judge ❑ NONE 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. El Ben White, Mayor ❑ Ron Gay, Place 3 ❑ David Ruesink, Place 6 City of College Station Elected Officials College Station City Council ❑ OPEN, Place 1 ❑ Lynn Mcllhaney, Place 4 \fX NONE ❑ James Massey, Place 2 0 Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Mary Fran Troy ❑ Sonio Margarita Gangotena El Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Donald Braune ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate 4INONE B/CS Library Committee 0 Katherine Edwards E l Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Weldon Kruger ❑ RC Slocum '14,\NONE Construction Board of Adjustments and Appeals/Building & Standards Commission El Frank Cox O Larry D. Patton O Glenn Thomas, alternate ❑ Don Scherr ❑ B. Carroll Johnson NONE ❑ Kevin Myers 0 Joe Wallace E l James Matson ❑ David Hart O Charles Thomas, alternate El Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright NONE ❑ Tedi Ellison El Rusleen Maurice VNONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton )/NONE ❑ John Nichols, Chair E l Marsha Sanford ❑ Harold Strong ❑ Rick Heaney ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ enise Whisenant NONE Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee El J. Kevin Byrne 0 Reba Ragdale Parks and Recreation Board El Kathleen Ireland ❑ Jody Ford ❑ Harry Green Planning and Zoning Commission ❑ Glenn Schroeder 0 Dennis Christiansen .k/NONE Design Review Board ❑ Hunter Goodwin El Ward Wells El Robert Rayburn, alternate Zoning Board of Adjustments El Joshua Benn ❑ Donald Braune ❑ Marguerite Anthony El Meredith Waller El Colleen Risinger ❑ Deborah Deitering ❑ Joan Perry ❑ Gary Thomas O Gary Erwin ❑ Derek Dictson O Bill Davis ❑ Nancy Sawtelle ❑ John Nichols tKr\TONE ❑ John Richards 0 Thomas Mather Research Valley Partnership Board of Directors ❑ Larry Hodges 0 Larry Mariott 0 Glenn Brown, City Manager ' NONE ❑ Sharon Colson, Chair O Kenny Mallard Wolf Pen Creek TIF Board ❑ Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair 0 Marc Chaloupka ❑ James Massey 'NONE Outside Agency Funding Review ❑ Don Lewis ❑ Charles Taylor ❑ Gregg Baird 0 Sheryl Welford ❑ Chad Jones HONE ❑ Stephen Syptak, Chair 0 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 0 Lloyd Wasserman, County Commission Northgate Tax Increment Finance Board ❑ David Scarmardo 0 Glenn Thomas Comprehensive Plan Committee ❑ 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 Mcllhaney, Alternate, Councilmember ❑ Gary Erwin, Parks & Rec ❑ Larry Haskins, Northgate District Assoc. ❑ Roger Reese ❑ Carolyn Berrow ❑ Anne Jackson ❑ Dale O'Reiley ❑ David Hart, Alternate, Area I ❑ Dennis Corrington, Alternate, Area 11 ❑ 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 O 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 O Chad Bohne, Intergovernmental Comm/TxDOT ❑ Michael Parks, Intergovernmental Comm/B VCOG ❑ Gary Arnold, Intergovernmental Comm/Brazos County Sheriff ❑ Gary Teston, Intergovernmental Comm/ Easterwood Airport )BONE 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 El Lynn Mcllhaney ❑ Ben White 14 NONE Brazos Valley Council of Governments ❑ Mayor NONE B/CS Metropolitan Planning Organization ❑ MayorNONE BVCOG TMPA Regional Park Project Advisory Board ❑ Lynn Mcllhaney NONE BVSWMA Policy Advisory Board 0 Mayor ❑ Chris Scotti *I NONE City Center Committee ❑ Ron Silvia El Ben White ❑ Dave Ruesink `NONE Intergovernmental Committee ❑ Ron Gay El Ben White El John Happ NONE ❑ Dave Ruesink NONE Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Dave Ruesink NONE Transportation Committee ❑ Ron Gay ❑ John Happ 0 Lynn Mcllhaney ❑ Ken Fogle ❑ Linda LaSuit, MPO ❑ Dennis Christianson, TTI ❑ Michael Parker, BVCOG 0 Bryan Woods, TxDOT NONE ❑ Ron Gay ❑ John Nichols ❑ Joan Perry Wolf Pen Creek Oversight Committee ❑ Chris Scotti 0 Marc Chaloupka ❑ Marsha Sanford ❑ Jodi Warner ❑ Sharon Colson WNONE 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 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. FORM CIQ 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 not from the local governmental the local government officer named in this section AND the taxablencome entity? Yes No C. Is the filer of this questionnaire affiliated with a ton or other an ownershipusiness entity that thof 10 percent or moreocal government officer serves as an officer or director, or holds Yes No D. Describe each affiliation or business relationship. 6. Signature of person doing ! siness with the governmental entity 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 Governm . An offensnd r this se on is a Class C misdemeanor. 1. Name of person doing business with local governmental entity. 2. OFFICE USE ONLY Date Received 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 Glenn Brown, City Manager O Robert Alley, Fire Chief O Pete Caler, Landfill Mgr. O David Gwin, Economic Dev. O David Massey, Electric 0 Bob Cowell, Planning & Dev 0 Cheryl Turney, Purchasing Mgr. El Terry Childers, Deputy City Mgr O Steve Beachy, Parks & Rec O Harvey Cargill, City Attorney O Connie Hooks, City Secretary El Becky Nugent, Public Relations O Mark Smith, Public Works O John Woody, W/WW CI Kathy Merrill, Asst. City Mgr. 0 Ben Roper, Inf. Tech. O Michael Clancey, Police Chief El Jeff Kersten, Chief Fin.Officer CI Julie O'Connell, Human Resources O Ed Spillane, Municipal Judge 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. City of College Station Elected Officials College Station City Council O Ben White, Mayor 0 OPEN, Place 1 O Ron Gay, Place 3 0 Lynn Mcllhaney, Place 4 O David Ruesink, Place 6 NONE City of College Station Committees, Boards, and Commissions O James Massey, Place 2 O Chris Scotti, Place 5 O Larry Ringer, Chairman O Mary Fran Troy O Sonio Margarita Gangotena O Sarah Adams, Chair O James Batenhorst O David Chester LI Donald Braune O Dan B. Sears, Chairman O Mike Lane kSteve Parker, alternate ONE B/CS Library Committee O Katherine Edwards O Jeanne Mitchell O James Bradford Cemetery Committee 0 Virginia Reese O Weldon Kruger LI RC Slocum NONE Construction Board of Adjustments and Appeals/Building & Standards Commission O Frank Cox O Larry D. Patton O Glenn Thomas, alternate CI Don Schen- O B. Carroll Johnson ONE El Kevin Myers O Joe Wallace O James Matson 0 David Hart O Charles Thomas, alternate O Quinn Williams O Hillary Jessup, Chairman O Haskell Monroe O Ernie Wright iA'NONE Historic Preservation Committee O Bill Lancaster O Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee O Marguerite Anthony O Meredith Waller El Colleen Risinger O Tedi Ellison 0 J. Kevin Byrne 0 Deborah Deitering O Rusleen Maurice 0 Reba Ragdale 0 ONE O Jodi Warner, Chair O Shawn Rhodes O John Crompton NE Parks and Recreation Board O Kathleen Ireland O Jody Ford O Harry Green Planning and Zoning Commission O John Nichols, Chair 0 Glenn Schroeder D Marsha Sanford 0 Dennis Christiansen 0 Harold Strong —NONE Design Review Board O Joan Perry El Gary Thomas 0 Gary Erwin O Derek Dictson O Bill Davis O Rick Heaney 0 Hunter Goodwin 0 Nancy Sawtelle O Alan King 0 Ward Wells 0 John Nichols O Susie Cox, alternate 0 Robert Rayburn, alternate elYN'ONE O Jay Goss, Chair O Denise Whisenant 44/ONE Zoning Board of Adjustments O Joshua Benn O Donald Braune O John Richards O Thomas Mather O Larry Hodges 0 Glenn Brown, City Manager O Sharon Colson, Chair O Kenny Mallard O Don Lewis O Gregg Baird O Chad Jones O Stephen Syptak, Chair O Tom Kirkland VNONE O Hugh Lindsay, Area I O John Crompton, Area II O Steve Arden, Area III O Hugh Stearns, Area IV O Andrew Burleson, Student Resident El Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation O Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors O Larry Marion NONE Wolf Pen Creek TIF Board 0 Chris Scotti, Councilman O Marsha Sanford, Vice Chair 0 Marc Chaloupka O James Massey NONE Outside Outside Agency Funding Review O Charles Taylor O Sheryl Welford kNONE Northgate Tax Increment Finance Board El David Scarmardo O Glenn Thomas Comprehensive Plan Committee O John Richards, Area I O Brian Bochner, Area II O Laurie Corbelli, Area HI O Jerry Cooper, Area IV O Kristina Campbell, Alternate, Student Resident O Craig Hall, Resident -At -Large O Lynn Mcllhaney, Alternate, Councilmember O Gary Erwin, Parks & Rec O Larry Haskins, Northgate District Assoc. 0 Roger Reese 0 Carolyn Berrow O Anne Jackson O Dale O'Reiley O David Hart, Alternate, Area I CI Dennis Corrington, Alternate, Area II O Tom Taylor, Alternate, Area III El Adrian Williams, Alternate, Area IV O Douglas Rape', ETJ Resident El Mike Guido, Alternate, Resident -At -Large 0 Bill Davis, P&Z O Kathleen Ireland, Parks & Rec Alternate O Bo Miles, Building & Land Development ❑ Larry Marriott, Home Builders Assoc. O 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 O 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 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. Brazos County Health Department O Lynn Mcllhaney 0 Ben White )(SrNONE Brazos Valley Council of Governments O Mayor itc-NONE B/CS Metropolitan Planning Organization O Mayor Et( NONE BVCOG TMPA Regional Park Project Advisory Board O Lynn McIlhaney IX NONE BVSWMA Policy Advisory Board O Mayor 0 Chris Scotti NONE O Ron Silvia kNONE City Center Committee 0 Ben White 0 Dave Ruesink Intergovernmental Committee C3 Ron Gay 0 Ben White 0 John Happ NONE O Dave Ruesink l'eSt NONE Joint City/School Intergovernmental Committee O Ben White 0 John Happ Sister Cities Association O Dave Ruesink NONE Transportation Committee O Ron Gay 0 John Happ 0 Lynn Mcllhaney O Ken Fogle 0 Linda LaSuit, MPO 0 Dennis Christianson, TTI O Michael Parker, BVCOG 0 Bryan Woods, TxDOT NONE O Ron Gay O John Nichols O Joan Perry Wolf Pen Creek Oversight Committee O Chris Scotti O Marsha Sanford O Sharon Colson O Marc Chaloupka O Jodi Warner NONE 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 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 doing b siness with the governmental entity /m6i 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. I. Name of person doing business with local governmental entity. 2. .S 04Ar LINZO-5 FORM CIQ OFFICE USE ONLY Date Received 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. CI Glenn Brown, City Manager O Robert Alley, Fire Chief O Pete Caler, Landfill Mgr. O David Gwin, Economic Dev. Li David Massey, Electric O Lance Simms, Planning & Dev Li Cheryl Turney, Purchasing Mgr. O Terry Childers, Deputy City Mgr 0 Steve Beachy, Parks & Rec O Harvey Cargill, City Attorney O Connie Hooks, City Secretary O Becky Nugent, Public Relations 0 Mark Smith, Public Works O John Woody, W/WW El Kathy Merrill, Asst. City Mgr. 0 Olivia Burnside, Inf. Tech. 0 Michael Clancey, Police Chief O Jeff Kersten, Chief Fin.Officer 0 Julie O'Connell, Human Resources O Ed Spillane, Municipal Judge ItNONE Describe each affiliation or business relationship with an employee checked in Question 3 above: Lincoln Community Center Parking Lot Addition Bid #07-84 CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE FORM CIQ 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. 0 Ron Silvia, Mayor O Ron Gay, Place 3 O David Ruesink, Place 6 City of College Station Elected Officials College Station City Council O Ben White, Place 1 El Lynn Mcllhaney, Place 4 X. NONE O John Happ, Place 2 0 Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman O Mary Fran Troy O Sonio Margarita Gangotena O Sarah Adams, Chair 0 James Batenhorst O David Chester O Donald Braune • Dan B. Sears, Chairman O Mike Lane El Steve Parker, alternate \(q NONE B/CS Library Committee O Katherine Edwards El Jeanne Mitchell O James Bradford Cemetery Committee O Virginia Reese 0 Weldon Kruger O RC Slocum NONE Construction Board of Adjustments and Appeals/Building & Standards Commission O Frank Cox O Larry D. Patton El Glenn Thomas, alternate O Don Scherr O B. Carroll Johnson 'NONE 0 Kevin Myers El Joe Wallace El James Matson O David Hart O Charles Thomas, alternate 0 Quinn Williams O Hillary Jessup, Chairman O Haskell Monroe O Ernie Wright NONE Historic Preservation Committee O Bill Lancaster O Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee O Marguerite Anthony O Meredith Waller O Colleen Risinger O Tedi Ellison 0 J. Kevin Byrne 0 Deborah Deitering O Rusleen Maurice 0 Reba Ragdale 0 tn NONE O Jodi Warner, Chair O Shawn Rhodes O John Crompton Xi NONE Parks and Recreation Board O Kathleen Ireland O Jody Ford O Harry Green Planning and Zoning Commission O John Nichols, Chair 0 Glenn Schroeder O Marsha Sanford 0 Dennis Christiansen O Harold Strong 131,, NONE El Rick Heaney O Alan King 0 Susie Cox, alternate O Jay Goss, Chair O Denise Whisenant \421 NONE Design Review Board O Hunter Goodwin O Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments O Joshua Benn O Donald Braune O Joan Perry O Gary Thomas O Gary Erwin O Derek Dictson O Bill Davis O Nancy Sawtelle O John Nichols ‘1A NONE O John Richards O Thomas Mather O Larry Hodges O Glenn Brown, City Manager O Sharon Colson, Chair O Kenny Mallard O Don Lewis O Gregg Baird O Chad Jones O Stephen Syptak, Chair O Tom Kirkland NONE O Hugh Lindsay, Area I O John Crompton, Area II O Steve Arden, Area III O Hugh Stearns, Area IV O Andrew Burleson, Student Resident O Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation O Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors O Larry Mariott NONE Wolf Pen Creek TIF Board O Marsha Sanford, Vice Chair O James Massey Outside Agency Funding Review O Charles Taylor O Sheryl Welford NONE Northgate Tax Increment Finance Board O David Scarmardo O Glenn Thomas Comprehensive Plan Committee O John Richards, Area I O Brian Bochner, Area II O Laurie Corbelli, Area III O Jerry Cooper, Area IV O Kristina Campbell, Alternate, Student Resident O Craig Hall, Resident -At -Large O Lynn Mcllhaney, Alternate, Councilmember O Gary Erwin, Parks & Rec O Larry Haskins, Northgate District Assoc. O Chris Scotti, Councilman O Marc Chaloupka kNONE O Roger Reese O Carolyn Berrow O Anne Jackson O Dale O'Reiley O David Hart, Alternate, Area I O Dennis Corrington, Alternate, Area II O Tom Taylor, Alternate, Area III O Adrian Williams, Alternate, Area IV O Douglas Rape', ETJ Resident O Mike Guido, Alternate, Resident -At -Large O Bill Davis, P&Z O Kathleen Ireland, Parks & Rec Alternate O 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 Conun/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 Th'e 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 O Lynn Mcllhaney 0 Ben White 00NE Brazos Valley Council of Governments O Ron Silvia, Mayor ONE B/CS Metropolitan Planning Organization O Ron Silvia, Mayor I'NONE BVCOG TMPA Regional Park Project Advisory Board O Lynn Mcllhaney GNONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Chris Scotti 'X NONE City Center Committee O Ron Silvia 0 Ben White 0 Dave Ruesink VONE Intergovernmental Committee O Ron Gay 0 Ben White 0 John Happ NONE EI Dave Ruesink Tit NONE Joint City/School Intergovernmental Committee 0 Ben White 0 John Happ Sister Cities Association O Dave Ruesink NONE Transportation Committee O Ron Gay 0 John Happ 0 Lynn Mcllhaney O Ken Fogle 0 Linda LaSuit, MPO 0 Dennis Christianson, TTI O Michael Parker, BVCOG 0 Bryan Woods, TxDOT 1KNONE Wolf Pen Creek Oversight Committee O Ron Gay 0 Chris Scotti 0 Marc Chaloupka O John Nichols 0 Marsha Sanford 0 Jodi Warner O Joan Perry 0 Sharon Colson 7,NONE 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 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 doing business with the governmental entity Adopted 01/13/06 Lincoln Community Center Parking Lot Addition Bid #07-84 CERTIFICATION CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE FORM CIQ 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. r4 1 - ppA 7 0S l Se ► f 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. ❑ Glenn Brown, City Manager ❑ Terry Childers, Deputy City Mgr ❑ Kathy Merrill, Asst. City Mgr. ❑ Robert Alley, Fire Chief 0 Steve Beachy, Parks & Rec 0 Olivia Burnside, Inf. Tech. ❑ Pete Cater, Landfill Mgr. 0 Harvey Cargill, City Attorney 0 Michael Clancey, Police Chief ❑ David Gwin, Economic Dev. ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Chief Fin.Officer ❑ David Massey, Electric 0 Becky Nugent, Public Relations 0 Julie O'Connell, Human Resources ❑ Lance Simms, Planning & Dev 0 Mark Smith, Public Works 0 Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. 0 John Woody, W/WW FsYNONE 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 ❑ 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 ❑ Sonio Margarita Gangotena ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Donald Braune ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate '11 -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 O Larry D. Patton ❑ Glenn Thomas, alternate ❑ Don Scherr ❑ B. Carroll Johnson [NONE ❑ Kevin Myers 0 Joe Wallace ❑ James Matson ❑ David Hart ❑ Charles Thomas, alternate ❑ Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright kit NONE ❑ Tedi Ellison ❑ Rusleen Maurice X NONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes O John Crompton CNONE ❑ John Nichols, Chair ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heaney ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Denise Whisenant IS NONE Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ J. Kevin Byrne O Reba Ragdale Parks and Recreation Board ❑ Kathleen Ireland O Jody Ford ❑ Harry Green Planning and Zoning Commission O Glenn Schroeder ❑ Dennis Christiansen V, 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 0 Deborah Deitering 0 ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin ❑ Derek Dictson 0 Bill Davis ❑ Nancy Sawtelle ❑ John Nichols NONE ❑ John Richards ❑ Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird O Chad Jones ❑ Stephen Syptak, Chair O Tom Kirkland r 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 El 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 ❑ Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ Kristina Campbell, Alternate, Student Resident ❑ Craig Hall, Resident -At -Large ❑ Lynn Mcllhaney, Alternate, Councilmember ❑ Gary Erwin, Parks & Rec ❑ Larry Haskins, Northgate District Assoc. ❑ Chris Scotti, Councilman ❑ Marc Chaloupka N. NONE ❑ Roger Reese ❑ Carolyn Berrow ❑ Anne Jackson ❑ Dale O'Reiley ❑ 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 El 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 O 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 0 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. Brazos County Health Department O Lynn Mcllhaney 0 Ben White 'NONE Brazos Valley Council of Governments O Ron Silvia, Mayor \ONE B/CS Metropolitan Planning Organization O Ron Silvia, Mayor ¥NONE BVCOG TMPA Regional Park Project Advisory Board ❑ Lynn Mcllhaney ONE BVSWMA Policy Advisory Board ❑ Ron Silvia, Mayor ❑ Chris Scotti NONE City Center Committee ❑ Ron Silvia ❑ Ben White ❑ Dave Ruesink L ZONE Intergovernmental Committee ❑ Ron Gay ❑ Ben White ❑ John Happ NONE ❑ Dave Ruesink g NONE Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Dave Ruesink (NONE Transportation Committee O Ron Gay ❑ John Happ 0 Lynn Mcllhaney O Ken Fogle 0 Linda LaSuit, MPO ❑ Dennis Christianson, TTI ❑ Michael Parker, BVCOG ❑ Bryan Woods, TxDOT RS -NONE ❑ Ron Gay ❑ John Nichols ❑ Joan Peny Wolf Pen Creek Oversight Committee ❑ Chris Scotti ❑ Marsha Sanford 0 Sharon Colson ❑ Marc Chaloupka ❑ Jodi Warner J NONE 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 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. FORM CIQ 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. t-).) Signature of p son doing business with the governmental entity 1/7 Date Adopted 01/13/06 CERTIFICATION eiret z0 vtI1-4 ✓Ic scribe each affiliation or business relationship with a person who is a local government officer and o appoints or employs a local government officer of the local government entity that is the subject of his 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 O Virginia Reese O Weldon Kruger ❑ RC Slocum 6a' NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Frank Cox O Larry D. Patton O Glenn Thomas, alternate ❑ Don Scherr ❑ B. Carroll Johnson NONE ❑ Kevin Myers ❑ Joe Wallace O James Matson ❑ David Hart ❑ Charles Thomas, alternate O Quinn Williams O Hillary Jessup, Chairman O Haskell Monroe O Ernie Wright *ONE O Rebecca Eplen O Rusleen Maurice NiA NONE O Jodi Warner, Chair O Shawn Rhodes O John Crompton NONE Historic Preservation Committee O Bill Lancaster O Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee O J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board O Kathleen Ireland O Jody Ford O Harry Green Planning and Zoning Commission O John Nichols, Chair 0 Glenn Schroeder O Marsha Sanford 0 Dennis Christiansen O Harold Strong ‘i;kNONE Design Review Board O Marguerite Anthony O Meredith Waller O Colleen Risinger O Deborah Deitering O Peggy Samson O Joan Perry O Gary Thomas O Gary Erwin O Derek Dictson O Bill Davis O Rick Heany 0 Hunter Goodwin 0 Nancy Sawtelle O Alan King 0 Ward Wells 0 John Nichols O Susie Cox, alternate 0 Robert Rayburn, alternate NONE O Jay Goss, Chair O Denise Whisenant NONE Zoning Board of Adjustments O Joshua Benn O Donald Braune O John Richards O Thomas Mather O Larry Hodges O Glenn Brown, City Manager O Sharon Colson, Chair O Kenny Mallard O Don Lewis 0 Gregg Baird O Chad Jones O Stephen Syptak, Chair O Tom Kirkland 1Q -ONE O Hugh Lindsay, Area I O John Crompton, Area II O Steve Arden, Area III O Hugh Stearns, Area IV O Andrew Burleson, Student Resident O Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation Cl Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors O Larry Marion NONE Wolf Pen Creek TIF Board O Marsha Sanford, Vice Chair O James Massey Outside Agency Funding Review O Charles Taylor O Sheryl Welford tl-N ONE Northgate Tax Increment Finance Board O David Scarmardo O Glenn Thomas Comprehensive Plan Committee O John Richards, Area I O Brian Bochner, Area II O Laurie Corbelli, Area III O Jerry Cooper, Area IV O Kristina Campbell, Alternate, Student Resident O Craig Hall, Resident -At -Large CI Lynn Mcllhaney, Alternate, Councilmember O Gary Erwin, Parks & Rec O Larry Haskins, Northgate District Assoc. O Chris Scotti, Councilman CI Marc Chaloupka O Roger Reese O Carolyn Berrow O Anne Jackson O Dale O'Riley O David Hart, Alternate, Area I CI Dennis Corrington, Alternate, Area II O Tom Taylor, Alternate, Area III O Adrian Williams, Alternate, Area IV O Douglas Rape', ETJ Resident O Mike Guido, Alternate, Resident -At -Large 0 Bill Davis, P&Z O Kathleen Ireland, Parks & Rec Alternate O Bo Miles, Building & Land Development O Larry Marriott, Home Builders Assoc. O Tedi Ellison, Intergovernmental Comm/Chamber of Commerce O James Massey, Intergovernmental Comm/TAMU Admin O Dr. Clark Ealy, Intergovernmental Comm/CS I SD O Chuck Martinez, Intergovernmental Comm/ Research Valley Patnership O Linda LaSut, Intergovernmental Comm/MPO O Lindsey Guindi, Intergovernmental Comm/Chamber of Commerce O Rodney Weis, Intergovernmental Comm/TAMU Transit O Dr. Colleen Netterville, Intergovernmental Comm/BISD O Margie Lucas, Intergovernmental Comm/ Brazos Transit District O Chad Bohne, Intergove Comm/TxDOT O Michael Parks, Intergovernmental Comm/BVCOG O Gary Arnold, Intergovernmental Comm/Brazos County Sheriff O Gary Teston, Intergovernmental Comm/ Easterwood Airport *NONE owing individuals are appointed by the City Council to represent the City of College Station on committees with other governmental agencies and community groups. Brazos County Health Department O Lynn Mcllhaney 0 Ben White g -NONE Brazos Valley Council of Governments O Ron Silvia, Mayor IrNONE B/CS Metropolitan Planning Organization O Ron Silvia, Mayor -6.NONE BVCOG TMPA Regional Park Project Advisory Board O Lynn Mcllhaney -NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Chris Scotti ..)Et -NONE City Center Committee O Ron Silvia 0 Ben White 0 Dave Ruesink R"NONE Intergovernmental Committee O Ron Gay 0 Ben White 0 John Happ WICIONE O Dave Ruesink 11l(NONE O Dave Ruesink O Ron Gay O Kett Fogle O Michael Parker, BVCOG O Ron Gay Joint City/School Intergovernmental Committee O Ben White 0 John Flapp Sister Cities Association ONE Transportation Committee O John Happ O Linda LaSuit, MPO O Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee O Chris Scotti O Lynn Mcllhaney O Dennis Christianson, TTI NONE NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: Adopted 01/13/06 LICT OF INTEREST QUESTIONNAIRE FORM CIQ endor 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. Signature of person oing usiness with the governmental entity Adopted 01/13/06 CERTIFICATION 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. 1. Name of person doing business with local governmental entity. 2. FORM CIQ OFFICE USE ONLY Date Received 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. CI Robert Alley, Fire Chief 0 Steve Beachy, Parks & Rec O Glenn Brown, City Manager O Olivia Burnside, Inf. Tech. O Pete Caler, Landfill Mgr. O Harvey Cargill, City Attorney kW ONE 0 Michael Clancey, Police Chief El Lance Simms, Planning & Dev O John Woody, W/WW CI Terry Childers, Deputy City Mgr 0 Connie Hooks, City Secretary O Jeff Kersten, Chief Fin.Officer LI O Becky Nugent, Public Relations O Julie O'Connell, Human Resources O Mark Smith, Public Works O Ed Spillane, Municipal Judge 0 Cheryl Turney, Purchasing Mgr. 0 David Massey, Electric Describe each affiliation or business relationship with an employee checked in Question 3 above: CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ 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 David Ruesink, Place 6 City of College Station Elected Officials College Station City Council O Ben White, Place 1 Li Lynn Mcllhaney, Place 4 g NONE O John Happ, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman O Mary Fran Troy Li Jennifer Bohac O Sarah Adams, Chair O James Batenhorst El David Chester O Donald Braune O Dan B. Sears, Chairman O Mike Lane 0 Steve Parker, alternate NONE B/CS Library Committee O Katherine Edwards El Jeanne Mitchell O James Bradford Cemetery Committee O Virginia Reese 0 Weldon Kruger El RC Slocum KNONE Construction Board of Adjustments and Appeals/Building & Standards Commission 0 Frank Cox 0 Larry D. Patton O Glenn Thomas, alternate 0 Don Scherr O B. Carroll Johnson IsxNONE O Kevin Myers 0 Joe Wallace Li James Matson O David Hart O Charles Thomas, alternate EJ Quinn Williams O Hillary Jessup, Chairman O Haskell Monroe O Ernie Wright KNONE O Rebecca Eplen Li Rusleen Maurice X NONE CI Jodi Warner, Chair O Shawn Rhodes O John Crompton NONE Historic Preservation Committee CI Bill Lancaster O Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee CI J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board O Kathleen Ireland O Jody Ford O Harry Green Planning and Zoning Commission Li John Nichols, Chair CI Glenn Schroeder O Marsha Sanford 0 Dennis Christiansen O Harold Strong NONE Design Review Board 0 Marguerite Anthony Li Meredith Waller O Colleen Risinger CI Deborah Deitering O Peggy Samson O Joan Perry O Gary Thomas O Gary Erwin O Derek Dictson O Bill Davis O Rick Heany CI Hunter Goodwin 0 Nancy Sawtelle O Alan King 0 Ward Wells 0 John Nichols O Susie Cox, alternate CI Robert Rayburn, alternate NONE Li 0 Jay Goss, Chair O Denise Whisenant NONE Zoning Board of Adjustments O Joshua Berm O Donald Braune O John Richards O Thomas Mather O Lany Hodges O Glenn Brown, City Manager O Sharon Colson, Chair O Kenny Mallard O Don Lewis O Gregg Baird 0 Chad Jones 0 Stephen Syptak, Chair O Tom Kirkland O NONE LI Hugh Lindsay, Area I O John Crompton, Area II O Steve Arden, Area III O Hugh Stearns, Area IV LI Andrew Burleson, Student Resident • Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation Cl Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors O Larry Mariott NONE Wolf Wolf Pen Creek TIF Board 0 Marsha Sanford, Vice Chair O James Massey Outside Agency Funding Review O Charles Taylor O Sheryl Welford (NONE Northgate Northgate Tax Increment Finance Board O David Scarmardo LI Glenn Thomas Comprehensive Plan Committee LI John Richards, Area I O Brian Bochner, Area Il O Laurie Corbelli, Area III O Jerry Cooper, Area IV O Kristina Campbell, Alternate, Student Resident O Craig Hall, Resident -At -Large LI Lynn Mcllhaney, Alternate, Councilmember O Gary Erwin, Parks & Rec O Larry Haskins, Northgate District Assoc. O Chris Scotti, Councilman O Marc Chaloupka X NONE O Roger Reese O Carolyn Berrow 0 Anne Jackson O Dale O'Riley 0 David Hart, Alternate, Area I O Dennis Corrington, Alternate, Area It O Tom Taylor, Alternate, Area III 0 Adrian Williams, Alternate, Area IV O Douglas Rape', ETJ Resident O Mike Guido, Alternate, Resident -At -Large O Bill Davis, P&Z LI Kathleen Ireland, Parks & Rec Alternate 0 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/CS ISD ❑ 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 1 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 O Ron Silvia, Mayor ❑ Ron Silvia, Mayor ❑ Lynn Mcllhaney ❑ Ron Silvia, Mayor O Ron Silvia NONE ❑ Ron Gay KNONE Brazos County Health Department 0 Ben White If NONE Brazos Valley Council of Governments NcNONE B/CS Metropolitan Planning Organization NONE BVCOG TMPA Regional Park Project Advisory Board NONE BVSWMA Policy Advisory Board O Chris Scotti City Center Committee O Ben White Intergovernmental Committee O Ben White 4„ NONE ❑ Dave Ruesink 0 John Happ O Dave Ruesink VCNONE Joint City/School Intergovernmental Committee O Ben White Sister Cities Association O Dave Ruesink NONE O Ron Gay O Ken Fogle O Michael Parker, BVCOG O Ron Gay Transportation Committee 0 John Happ O Linda LaSuit, MPO O Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee O Chris Scotti O John Happ O Lynn Mcllhaney O Dennis Christianson, TTI ,?f2; NONE NONE Describe 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. ILSignatu e of person doi business with the governmental entity Date Adopted 01/13/06 STANDARD FORM OF AGREEMENT 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 I cal governmental%� entity. 67 a A 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 ❑ David Massey, Electric ❑ Michael Clancey, Police Chief ❑ Lance Simms, Planning & Dev ❑ John Woody, W/WW ❑ Terry Childers, Asst. City Mgr ❑ Connie Hooks, City Secretary El Jeff Kersten, Chief Fin.Officer ❑ Charles McLemore, Public Works El Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources Cl Mark Smith, Asst. City Mgr ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. rlikNONE 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. City of College Station Elected Officials College Station City Council ❑ Ron Silvia, Mayor 0 Ben White, Place I ❑ Ron Gay, Place 3 ❑ Lynn McI Ihaney, Place 4 ❑ David Ruesink, Place 6 I(NONE ❑ John Happ, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ Larry Ringer, Chairman 0 Katherine Edwards 0 Don Scherr ❑ Eric Miller El Jeanne Mitchell 0 Jo Berg ❑ Lois Koontz 0 James Bradford L'NONE Cemetery Committee ❑ Sarah Adams, Chair ❑ Virginia Reese ❑ James Batenhorst El Mary Lind Bryan ❑ David Chester IIONE O Dan B. Sears, Chairman O Mike Lane O Steve Parker, alternate ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev NONE Construction Board of Adjustments and Appeals/Building & Standards Commission O George McLean, Vice Chair ❑ Larry D. Patton ❑ David Ruesink, alternate Facade Improvement Program Advisory Committee O Kevin Myers O Joe Wallace ❑ Frank Cox O David Hart, alternate ONE O Valerian Miranda, Architect 0 Rick Lemmons, Business Owner O Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator ❑ Hillary Jessup, Chairman O Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger O Rebecca Eplen ❑ Rusleen Maurice NONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton V NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy O Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright .8r 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 O John Nichols ❑ Dennis Christiansen 'NONE Design Review Board ❑ Hunter Goodwin O Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments O Joshua Benn ❑ Donald Braune ❑ Derek Dictson ❑ Marsha Crenwelge ❑ Dipankar Sen O Neal Nutall, Jr. O Mary Sherwood O Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer N- NONE ❑ John Richards ❑ Charles Taylor NONE Research Valley Partnership Board of Directors ❑ David Hickson 0 Larry Mariott ❑ Glenn Brown, City Manager gNONE ❑ Sharon Colson, Chair O Kenny Mallard Wolf Pen Creek TIF Board 0 Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair ❑ Marc Chaloupka 0 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. Brazos County Health Department O Susan Lancaster 0 Nancy Berry IX NONE Brazos Valley Council of Governments Board of Directors O Ron Silvia, Mayor `'NONE B/CS Metropolitan Planning Organization O Ron Silvia, Mayor NONE BVCOG TMPA Regional Park Project Advisory Board O Susan Lancaster 6NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Susan Lancaster (ONE ❑ Ron Silvia NONE ❑ Nancy Berry NONE ❑ Nancy Berry IYrNONE City Center Committee 0 Ben White 0 Nancy Berry Intergovernmental Committee 0 Ben White 0 John Happ Joint City/School Intergovernmental Committee 0 Ben White 0 John Happ Sister Cities Association O Ron Gay OCNIONE ❑ Ron Gay ❑ Linda LaSuit, MPO O Bryan Woods, TxDOT Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI cik, NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Wolf Pen Creek Oversight Committee 0 Ron Gay 0 Chris Scotti CNONE 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 p rson doing business with the governmental entity Die 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 ith local governmental entity. 456 14Z?Azds O4/4�C0 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 ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief O Joey Dunn, Planning & Dev ❑ Don Fazzino, Legislative Liason ❑ Charles Wood, Economic Dev O Connie Hooks, City Secretary ❑ eff Kersten, Finance NONE ❑ Charles McLemore, Public Works O Becky Nugent, Public Relations El Julie O'Connell, Human Resources ❑ Mark Smith, Public Works O Ed Spillane, Municipal Judge O 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 El Ron Gay, Place 3 ❑ Nancy Berry, Place 6 City of College Station Elected Officials College Station City Council O Ben White, Place 1 0 John Happ, Place 2 ❑ Susan Lancaster, Place 4 ❑ Chris Scotti, Place 5 NONE City of College Station Committees, Boards, and Commissions B/CS Library Committee El Larry Ringer, Chairman ❑ Katherine Edwards 0 Don Scherr El Eric Miller 0 Jeanne Mitchell ❑ Jo Berg ❑ Lois Koontz ❑ James Bradford 1WNONE Cemetery Committee O Sarah Adams, Chair 0 Virginia Reese O James Batenhorst 0 Mary Lind Bryan El David Chester ''NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Kevin Myers ❑ Joe Wallace ❑ Dan B. Sears, Chairman El George McLean, Vice Chair 0 Frank Cox ❑ Mike Lane 0 Larry D. Patton 0 David Hart, alternate O Steve Parker, alternate ❑ David Ruesink, alternate 4rISIONE ❑ Karen Kasper, Merchant W❑ oey Dunn, Dir. Planning & Dev NONE Facade Improvement Program Advisory Committee ❑ Valerian Miranda, Architect 0 Rick Lemmons, Business Owner ❑ Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice XONE ❑ Kathleen Ireland O Carol Blaschke KNONE ❑ JJohn Crompton ❑ Scott Shafer, Chairman ❑ Marsha Sanford El Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate O Jay Goss, Chair O Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster O David Ruesink ❑ Ernie Wright NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board O Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission O John Nichols ❑ Dennis Christiansen N- NONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate O Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. O Mary Sherwood O Peggy Samson O Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle O Scott Shafer WIONE Zoning Board of Adjustments ❑ Joshua Benn ❑ John Richards ❑ Donald Braunearles Taylor 0 Derek Dictson KNONE Research Valley Partnership Board of Directors ❑ David Hickson 0 Larry Mariott ❑ Glenn Brown, City Manager 'NONE ❑ Sharon Colson, Chair ❑ Kenny Mallard Wolf Pen Creek TIF Board 0 Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair 0 Marc 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. Brazos County Health Department ❑ Susan Lancaster ❑ Nancy Berry ``NONE Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayor [ TONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor ZONE BVCOG TMPA Regional Park Project Advisory Board ❑ Susan Lancaster ® NONE BVSWMA Policy Advisory Board ❑ Ron Silvia, Mayor 0 Susan Lancaster NONE ❑ Ron Silvia NONE ❑ Nancy Berry (NONE ❑ Nancy Berry TONE ❑ Ron Gay ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT City Center Committee ❑ Ben White 0 Nancy Berry Intergovernmental Committee ❑ Ben White ❑ John Happ Joint City/School Intergovernmental Committee ❑ Ben White 0 John Happ Sister Cities Association NONE Transportation Committee ❑ John Happ O ennis Christianson, TTI ONE ❑ Ken Fogle O Michael Parker, BVCOG Wolf Pen Creek Oversight Committee ❑ Ron Gay O Chris Scotti elil--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 doing business with the governmental entity Date Adopted 01/13/06 CERTIFICATION 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. 1. Name of person doing business with local governmental entity. 2. 2 OFFICE USE ONLY Date Received 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. O Robert Alley, Fire Chief O Steve Beachy, Parks & Rec O Glenn Brown, City Manager O Olivia Burnside, Inf. Tech. 0 Pete Caler, Landfill Mgr. O 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 ONE O Charles McLemore, Public Works O Becky Nugent, Public Relations O Julie O'Connell, Human Resources O Mark Smith, Public Works O Ed Spillane, Municipal Judge O Cheryl Turney, Purchasing Mgr. Describe each affiliation or business relationship with an employee checked in Question 3 above: Brazos Transmission Power Line R -O -W Clearing Bid 06-82 CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRE FORM CIQ If 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. City of College Station Elected Officials College Station City Council El Ron Silvia, Mayor 0 Ben White, Place 1 El Ron Gay, Place 3 0 Susan Lancaster, Place 4 O Nancy Berry, Place 6 lg.NONE O John Happ, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions B/CS Library Committee O Larry Ringer, Chairman El Katherine Edwards 0 Don Scherr O Eric Miller 0 Jeanne Mitchell 0 Jo Berg 0 Lois Koontz 0 James Bradford '(NONE Cemetery Committee O Sarah Adams, Chair 0 Virginia Reese 0 James Batenhorst 0 Mary Lind Bryan O David Chester pk NONE Construction Board of Adjustments and Appeals/Building & Standards Commission El Kevin Myers O Joe Wallace O Dan B. Sears, Chairman 0 George McLean, Vice Chair 0 Frank Cox El Mike Lane 0 Larry D. Patton 0 David Hart, alternate 0 Steve Parker, alternate El David Ruesink, alternate NONE El Karen Kasper, Merchant O Joey Dunn, Dir. Planning & Dev NONE Facade Improvement Program Advisory Committee El Valerian Miranda, Architect El Rick Lemmons, Business Owner CI Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator O Hillary Jessup, Chairman O Marguerite Anthony O Thomas Taylor O Colleen Risinger O Rebecca Eplen O Rusleen Maurice )54 NONE O Kathleen Ireland O Carol Blaschke O John Crompton e\1ONE O Scott Shafer, Chairman O Marsha Sanford O Harold Strong O Rick Heany O Alan King O Susie Cox, alternate O Jay Goss, Chair O Graham Sheffy O Denise Whisenant Historic Preservation Committee O Bill Lancaster O David Ruesink O Ernie Wright il<NONE Joint Relief Funding Review Committee O J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board O Glenn Schroeder O Jeannie McCandless O Harry Green Planning and Zoning Commission O John Nichols O Dennis Christiansen NONE Design Review Board O Hunter Goodwin O Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments O Joshua Benn O 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 O Bill Davis O Nancy Sawtelle O Scott Shafer NONE O John Richards O Charles Taylor /1(‘TONE O David Hickson Research Valley Partnership Board of Directors O Larry Mariott O Glenn Brown, City Manager NONE O Sharon Colson, Chair O Kenny Mallard Wolf Pen Creek TIF Board 0 Chris Scotti, Councilman O Marsha Sanford, Vice Chair 0 Marc Chaloupka O James Massey 1SeNONE 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 O Susan Lancaster 0 Nancy Berry 1NONE Brazos Valley Council of Governments Board of Directors O Ron Silvia, Mayor NONE B/CS Metropolitan Planning Organization O Ron Silvia, Mayor Ng NONE BVCOG TMPA Regional Park Project Advisory Board O Susan Lancaster Nti NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Susan Lancaster EkTONE O Ron Silvia )!q NONE O Nancy Berry 12t NONE O Nancy Berry 'NONE O Ron Gay O Ron Gay O Linda LaSuit, MPO O Bryan Woods, TxDOT City Center Committee O Ben White Intergovernmental Committee O Ben White Joint City/School Intergovernmental Committee O Ben White Sister Cities Association NONE Transportation Committee O John Happ O Dennis Christianson, TTI NONE O Nancy Berry O John Happ O John Happ O Ken Fogle O Michael Parker, BVCOG Wolf Pen Creek Oversight Committee O Ron Gay O Chris Scotti NONE 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 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. FORM CIQ 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 persdn do g business with the governmental entity Adopted 01/13/06 Brazos Transmission Power Line R -O -W Clearing Bid 0642 CERTIFICATION