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HomeMy WebLinkAboutOffice DepotCONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person doing business with the governmental entity. By law this questionnaire must be filed with the records administrator of the local government not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code. A person committs an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. 1. Name of person doing business with local governmental entity. 2. OFFICE USE ONLY Date Received Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year for which an activity described in Section 176.006(a), Local Government Code, is pending and not later than the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3. Describe each affiliation or business relationship with an employee or contractor of the local governmental entity who makes recommendations to a local government officer of the local governmental entity with respect to expenditure of money. ❑ Robert Alley, Fire Chief ❑ Steve Beachy, Parks & Rec ❑ Glenn Brown, City Manager ❑ Olivia Burnside, Inf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev ❑ Don Fazzino, Legislative Liason ❑ Charles Wood, Economic Dev ❑ Connie Hooks, City Secretary ❑i Kersten, Finance NONE ❑ Charles McLemore, Public Works ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Public Works ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. Describe each affiliation or business relationship with an employee checked in Question 3 above: 4. Describe each affiliation or business relationship with a person who is a local government officer and who appoints or employs a local government officer of the local government entity that is the subject of this questionnaire. ❑ Ron Silvia, Mayor ❑ Ron Gay, Place 3 ❑ Nancy Berry, Place 6 City of College Station Elected Officials College Station City Council ❑ Ben White, Place 1 0 John Happ, Place 2 O Susan Lancaster, Place 4 0 Chris Scotti, Place 5 El NONE City of College Station Committees, Boards, and Commissions B/CS Library Committee ❑ Larry Ringer, Chairman 0 Katherine Edwards 0 Don Scherr ❑ Eric Miller 0 Jeanne Mitchell ❑ Jo Berg ❑ Lois Koontz 0 James Bradford [3'NONE Cemetery Committee ❑ Sarah Adams, Chair 0 Virginia Reese ❑ James Batenhorst 0 Mary Lind Bryan ❑ David Chester E/NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Kevin Myers ❑ Joe Wallace ❑ Dan B. Sears, Chairman 0 George McLean, Vice Chair 0 Frank Cox ❑ Mike Lane 0 Larry D. Patton 0 David Hart, alternate ❑ Steve Parker, alternate ❑ David Ruesink, alternate NONE Facade Improvement Program Advisory Committee ❑ Karen Kasper, Merchant 0 Valerian Miranda, Architect 0 Rick Lemmons, Business Owner ❑ Joey Dunn, Dir. Planning & Dev 0 Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator 07NONE ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen O Rusleen Maurice (NONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton a 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 El Bill Lancaster ❑ David Ruesink ❑ Ernie Wright Q` NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless O Harry Green Planning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen 121/NONE Design Review Board ❑ Hunter Goodwin O Ward Wells ❑ Robert Rayburn, alternate ❑ Marsha Crenwelge O Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood ❑ Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds O Bill Davis ❑ Nancy Sawtelle O Scott Shafer l;1 NONE Zoning Board of Adjustments ❑ Joshua Benn ❑ John Richards O Donald Braune 0 Charles Taylor Cl Derek Dictson 04NONE Research Valley Partnership Board of Directors O David Hickson 0 Larry Mariott O Glenn Brown, City Manager CVNONE O Sharon Colson, Chair O 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 O Susan Lancaster 0 Nancy Berry I3'NONE Brazos Valley Council of Governments Board of Directors O Ron Silvia, Mayor 12/NONE B/CS Metropolitan Planning Organization O Ron Silvia, Mayor DONE BVCOG TMPA Regional Park Project Advisory Board O Susan Lancaster Le -NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Susan Lancaster Et' NONE ❑ Ron Silvia IEJ'NONE ❑ Nancy Berry EW ONE ❑ Nancy Berry E94 ONE City Center Committee O Ben White 0 Nancy Berry Intergovernmental Committee O Ben White 0 John Happ Joint City/School Intergovernmental Committee ❑ Ben White 0 John Happ Sister Cities Association O Ron Gay D NONE Transportation Committee ❑ Ron Gay 0 John Happ ❑ Linda LaSuit, MPO 0 Dennis Christianson, TTI ❑ Bryan Woods, TxDOT [NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Wolf Pen Creek Oversight Committee O Ron Gay O Chris Scotti EI 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 VI 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. R cart Skws)on beAftalf v� D 4'et--KX' IM POLLMAN 'egional Vice President antral Region Signature of person doing business with the governmental entity [)ate Adopted 01/13/06