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HomeMy WebLinkAboutHarpole, JohnCONFLICT 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. T611,1 f49rpac 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. ❑ Robert Alley, Fire Chief ❑ Steve Beachy, Parks & Rec ❑ Glenn Brown, City Manager ❑ Olivia Burnside, Inf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev O Don Fazzino, Legislative Liason ❑ Kim Foutz, Economic Dev ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Finance [NONE O Charles McLemore, Public Works ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge O Cheryl Turney, Purchasing Mgr. Describe each affiliation or business relationship with an employee checked in Question 3 above: 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 El Ron Silvia, Mayor El Ben White, Place 1 E l Ron Gay, Place 3 0 Susan Lancaster, Place 4 ❑ Nancy Berry, Place 6 [NONE El John Happ, Place 2 El Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ Larry Ringer, Chairman ❑ Katherine Edwards ❑ Don Schen ❑ Eric Miller ❑ Jeanne Mitchell 0 Jo Berg El Lois Koontz El James Bradford ft -NONE Cemetery Committee El Sarah Adams, Chair ❑ Virginia Reese ❑ James Batenhorst El Mary Lind Bryan ❑ David Chester!la'NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Kevin Myers El Joe Wallace El Dan B. Sears, Chairman El George McLean, Vice Chair ❑ Frank Cox El Mike Lane ❑ Larry D. Patton ❑ David Hart, alternate El Steve Parker, alternate El David Ruesink, alternate DONE Facade Improvement Program Advisory Committee ❑ Karen Kasper, Merchant ❑ Valerian Miranda, Architect El Rick Lemmons, Business Owner E❑ Joey Dunn, Dir. Planning & Dev El Robert Mosley, City Engineer El Eric Barton, CD Coordinator NONE ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor O Colleen Risinger ❑ Rebecca Eplen ❑ R5usleen Maurice VNONE O Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton NONE ❑ Scott Shafer, Chairman El Marsha Sanford O Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate El Jay Goss, Chair O Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster El David Ruesink O Ernie Wright ild' NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne El Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission O John Nichols O Dennis Christiansen ale<ONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood ❑ Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer DONE Zoning Board of Adjustments ❑ Joshua Benn 0 John Richards ❑ Donald Braune ❑ Charles Taylor ❑ Derek Dictson VKI ONE Research Valley Partnership Board of Directors ❑ David Hickson �❑ Larry Mariott [ 0 Glenn Brown, City Manager ONE ❑ Sharon Colson, Chair ❑ Kenny Mallard Wolf Pen Creek TIF Board ❑ Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair 0 Marc Chaloupka ❑ James Massey 11KONE 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 UKVONE Brazos Valley Council of Governments Board of Directors 0 Ron Silvia, Mayor 144NE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor Ep4 ONE BVCOG TMPA Regional Park Project Advisory Board ❑ Susan Lancaster NONE BVSWMA Policy Advisory Board 0 Ron Silvia, Mayor 0 Susan Lancaster SONE ❑ Ron Silvia P4 ONE ❑ Nanc Berry 4.1•16NE ��❑ Nancy Berry �LYNONE ❑ Ron Gay ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee ❑ Ben White 0 John Happ Joint City/School Intergovernmental Committee 0 Ben White 0 John Happ Sister Cities Association Lot" NONE Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI IG�'NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Wolf Pen Creek Oversight Committee O Ron Gay 0 Chris Scotti Et 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 I // I 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 I r /I No D. Describe each affiliation or business relationship. 6. gnature of person dot g business with the governmental entity Date Adopted 01/13/06