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Home My WebLink AboutVoices for ChildrenCONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire is being fled 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. V0 IeCCS 2. OFFICE USE ONLY Date Received 4 ti- Ch i Lal'rer1 n� / 6ee 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 O Olivia Burnside, Inf. Tech. O Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief ❑ Charles McLemore, Public Works ❑ Joey Dunn, Planning & Dev ❑ Becky Nugent, Public Relations ❑ Don Fazzino, Legislative Liason ❑ Julie O'Connell, Human Resources ❑ Kim Foutz, Economic Dev ❑ Mark Smith, Public Works ❑ Connie Hooks, City Secretary ❑ Ed Spillane, Municipal Judge ❑ Jeff Kersten, Finance Cheryl Turney, Purchasing Mgr. ❑ NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: 7n4- ►n, a.. C v vehA_ , z... �B-t✓c� G,�.�:,.�' n4- 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 ❑ Ben White, Place 1 O Ron Gay, Place 3 ❑ Susan Lancaster, Place 4 ❑ Nancy Berry, Place 6 CLONE City of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ Larry Ringer, Chairman ❑ Katherine Edwards ❑ Don Scherr ❑ Eric Miller ❑ Jeanne Mitchell ❑ Jo Berg ❑ Lois Koontz ❑ James Bradford [LONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 Cemetery Committee ❑ Sarah Adams, Chair ❑ Virginia Reese ❑ James Batenhorst Cl Mary Lind Bryan ❑ David Chester L9'N/ONE Construction Board of Adjustments and Appeals/Building & Standards Commission Cl Kevin Myers 0 Joe Wallace ❑ Dan B. Sears, Chairman ❑ George McLean, Vice Chair ❑ Frank Cox O Mike Lane ❑ Larry D. Patton ❑ David Hart, alternate ❑ Steve Parker, alternate ❑ David Ruesink, alternate IIXONE ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev 19'NONE 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 O Colleen Risinger Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright Eg'NONE Joint Relief Funding Review Committee ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Rebecca Eplen ❑ J. Kevin Byrne ❑ Mary Sherwood Q'Rusleen Maurice ` ❑ Charlotte Mikulee ❑ Peggy Samson ❑ NONE 1D e� or. a Cornry - r - LOI \)F0-- F{DG. r\o corrrn4- ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton R./NONE O Scott Shafer, Chairman O Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen LW ONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Derek Dictson O Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds LI Bill Davis lam' Nancy Sawtelle O Scott Shafer ❑ NONE 5e tAX'S On a CDmrr,, 4-6e cor VR._ ❑ John Richards ❑ Charles Taylor ONE Research Valley Partnership Board of Directors ❑ David Hickson ❑ Larry Mariott ❑ Glenn Brown, City Manager R4 ONE ❑ Sharon Colson, Chair ❑ Kenny Mallard Wolf Pen Creek TIF Board ❑ Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair ❑ Marc Chaloupka ❑ James Massey p'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 GXNONE Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayor Q NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor Q" NONE BVCOG TMPA Regional Park Project Advisory Board ❑ Susan Lancaster LVIVONE BVSWMA Policy Advisory Board 0 Ron Silvia, Mayor 0 Susan Lancaster LW ONE ❑ Ron Silvia Ii 'NONE ❑ Nancy Berry CY4ON E ❑ Nancy Berry ITY ONE City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee ❑ Ben Whit. ❑ John Happ Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Ron Gay Q'<ONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI I3�ONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Describe each affiliation or business relationship with an employee checked in Question 4 above: u,slePr) matArc-e-- �etrV�n� car. a a r m, 4ee F -I at, , (lay) onyr- (1an s of._ a own m i Wee C b «liter latr+ a uch`on) to' Adopted 01/13/06 Wolf Pen Creek Oversight Committee Ron Gay Chris Scotti 1a' 4ONE • • Describe each affiliation or business relationship with an employee checked in Question 4 above: u,slePr) matArc-e-- �etrV�n� car. a a r m, 4ee F -I at, , (lay) onyr- (1an s of._ a own m i Wee C b «liter latr+ a uch`on) to' 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 X 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 X 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 x No D. Describe each affiliation or business relationship. 6. 0..eactut BaL h e„ Signature of person doing business with the governmental entity 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 J Name of person doing business with local governmental entity. ')O I ee rOr 6re ►1 r- / ee d ra 44 , Baker 2j filing authority not later than Code, is pending and incomplete or inaccurate.) Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate September 1 of the year for which an activity described in Section 176.006(a), Local Government not later than the 7th business day after the date the originally filed questionnaire becomes =1 Name each employee or contractor of the local governmental entity who makes recommendations to a local government officer of the governmental entity with respect to expenditures of money AND describe the affiliation or business relationship. Chir j1 Turr\ec�) qtrchosrAi moan. YY15 . Mr nee )'s a OA.`-- Od u R-I-eer— LA) hi—t,_. U0 ;a s For ekitUr.\I ne`- 4 Name each local government officer who appoints or employs local government officers of the governmental entity for which this questionnaire is filed AND describe the affiliation or business relationship. -US6eo . Matin CO---5e-6A-Ye- 6r- a e-cormANl 4---e -E 0- to -F j 66 (,_ll nertne,Lfr sau-etle_ 5 s vt• a \44-6i SI Aft/ Co fV -1-6. fns ) Adopted 11/02/2005 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ Page 2 Name of local government officer with whom filer has affilitation or business relationship. (Complete this section only if the answer to A, B, or C is YES.) 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. 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 V 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 D. Describe each affiliation or business relationship. 12-0 Ala (r4 4--7- o Signature of person doing business with the governmental entity Date Adopted 11/02/2005