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HomeMy WebLinkAboutQuality Tower 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. FORM CIQ OFFICE USE ONLY Date Received 1. Name of person doing business with local governmental entity. &UAL/ /(JWe.< °t21/1ees/ 1. / J . - 4oRGE. P • dACKSo ry 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 0 Michael Clancey, Police Chief 0 Charles McLemore, Public Works ❑ Steve Beachy, Parks & Rec 0 Lance Simms, Planning & Dev 0 Becky Nugent, Public Relations ❑ Glenn Brown, City Manager 0 John Woody, W/WW 0 Julie O'Connell, Human Resources ❑ Olivia Burnside, Inf. Tech. 0 Charles Wood, Economic Dev 0 Mark Smith, Special Projects ❑ Pete Caler, Landfill Mgr. 0 Connie Hooks, City Secretary 0 Ed Spillane, Municipal Judge O Harvey Cargill, City Attorney 0 Jeff Kersten, Finance 0 Cheryl Turney, Purchasing Mgr. O David Massey, Electric 0 Charles McLemore, Public Works NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: W/P 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 McIlhaney, Place 4 l:8 NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Eric Miller O Lois Koontz ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester B/CS Library Committee ❑ Katherine Edwards O Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Mary Lind Bryan El NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Don Scherr ❑ Jo Berg 13 NONE O Kevin Myers O Joe Wallace ❑ Dan B. Sears, Chairman 0 George McLean, Vice Chair 0 Frank Cox O Mike Lane 0 Larry D. Patton 0 David Hart, alternate ❑ Steve Parker, alternate 0 David Ruesink, alternate NONE ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev NONE Facade Improvement Program Advisory Committee ❑ Valerian Miranda, Architect 0 Rick Lemmons, Business Owner O Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice IR NONE ❑ Kathleen Ireland O Carol Blaschke ❑ John Crompton El NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford O Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright Si NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen • NONE Design Review Board ❑ Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Derek Dictson ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood ❑ Peggy Samson O Jodi Warner O Gary Thomas O Gary Erwin ❑ Ken Reynolds ❑ Bill Davis O Nancy Sawtelle O Scott Shafer 12( NONE Cl John Richards ❑ Charles Taylor In NONE ❑ David Hickson ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard Research Valley Partnership Board of Directors ❑ Larry Mariott El NONE Wolf Pen Creek TIF Board ❑ Marsha Sanford, Vice Chair ❑ James Massey 0 Chris Scotti, Councilman ❑ Marc Chaloupka ER NONE The following individuals are appointed by the City Council to represent the City of College Station on joint committees with other governmental agencies and community groups. ❑ Susan Lancaster ❑ Ron Silvia, Mayor ❑ Ron Silvia, Mayor ❑ Susan Lancaster ❑ Ron Silvia, Mayor Brazos County Health Department O Nancy Berry NONE Brazos Valley Council of Governments Board of Directors 6d NONE B/CS Metropolitan Planning Organization 121 NONE BVCOG TMPA Regional Park Project Advisory Board Il NONE BVSWMA Policy Advisory Board O Susan Lancaster GO NONE O Ron Silvia N NONE ❑ Nancy Berry • NONE ❑ Nancy Berry ® NONE City Center Committee O Ben White 0 Nancy Berry Intergovernmental Committee O Ben White ❑ John Happ Joint City/School Intergovernmental Committee O Ben White 0 John Happ Sister Cities Association O Ron Gay ll NONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI Eig NONE ❑ 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 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. Signatur- of person doing business with the governmental entity Date Adopted 01/13/06 CERTIFICATION