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HomeMy WebLinkAboutMejorando Group, TheCONFLICT OF INTEiEST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire is being fi ed in accordance with chapter 176 of the Local Government Code by a persol 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. 2. rye._ d bc, The nig.) Druid 6dLf Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file ar updated completed questionnaire with the appropriate filing authority not later than September 1 of the year for whici an activity described in Section 176.006(a), Local Government Code, is pending and not later than the 7th business da' after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3. Describe each affiliation dr 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. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorny O David Massey, Electric ❑ Michael Clancey, Police Chief ❑ Lance Simms, Planning & Dev ❑ John Woody, W/WW ❑ Terry Childers, Asst. City Mgr ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Chief Fin.Officer ❑ Charles McLemore, Public Works O Becky Nugent, Public Relations l''Julie O'Connell, Human Resources ❑ Mark Smith, Asst. City Mgr ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. O NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: ii Q j S Mk i n cI 0 E 604 dor S u CCe JS i m Plan n1 h13 Sef vt res 4. Describe each affiliation who appoints or employs a this questionnaire. ❑ Ron Silvia, Mayor ❑ Ron Gay, Place 3 ❑ David Ruesink, Place 6 or business relationship with a person who is a local government officer and ocal government officer of the local government entity that is the subject of City of College Station Elected Officials College Station City Council ❑ Ben White, Place 1 ❑ Lynn McIlhaney, Place 4 y NONE City of College Station Committees, Boards, and Commissions ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 ❑ Larry Ringer, Chairman ❑ Eric Miller ❑ Lois Koontz ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester O Dan B. Sears, Chairman O Mike Lane ❑ Steve Parker, alternate B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Mary Lind Bryan l NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ George McLean, Vice Chair ❑ Larry D. Patton ❑ David Ruesink, alternate Facade Improvement Program Advisory Committee ❑ Don Scherr ❑ Jo Berg / NONE O Kevin Myers O Joe Wallace ❑ Frank Cox ❑ David Hart, alternate y NONE ❑ Karen Kasper, Merchant 0 Valerian Miranda, Architect 0 Rick Lemmons, Business Owner ❑ Joey Dunn, Dir. Planning & 1 ev 0 Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator O NONE ❑ Hillary Jessup, Chairman O Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen O Rusleen Maurice 7 NONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton sit NONE O Scott Shafer, Chairman O Marsha Sanford O Harold Strong ❑ Rick Heany ❑ Alan King O Susie Cox, alternate O Jay Goss, Chair O Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink O Ernie Wright 41 NONE Joint Relief Funding Review Committee O J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen l NONE Design Review Board ❑ Hunter Goodwin O Ward Wells ❑ Robert Rayburn, alternate ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. O Mary Sherwood ❑ Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds O Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer NONE Zoning Board of Adjustments O Joshua Benn 0 John Richards O Donald Braune 0 Charles Taylor O Derek Dictson 17NONE Research Valley Partnership Board of Directors ❑ David Hickson ❑ Larry Mariott ❑ Glenn Brown, City Mana; er fl NONE ❑ Sharon Colson, Chair ❑ Kenny Mallard The following individuals a Wolf Pen Creek TIF Board El Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair ❑ Marc Chaloupka 0 James Massey L 'NONE appointed by the City Council to represent the City of College Station on joint committees with other overnmental agencies and community groups. ❑ Susan Lancaster ❑ Ron Silvia, Mayor ❑ Ron Silvia, Mayor ❑ Susan Lancaster ❑ Ron Silvia, Mayor Brazos County Health Department ❑ Nancy Berry NONE Brazos Valley Council of Governments Board of Directors �1 NONE B/CS Metropolitan Planning Organization 111 NONE BVCOG TMPA Regional Park Project Advisory Board NONE BVSWMA Policy Advisory Board 0 Susan Lancaster 7 NONE ❑ Ron Silvia Ti NONE ❑ Nancy Berry ja NONE ❑ Nancy Berry V NONE 0 Ron Gay ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee O Ben White ❑ John Happ Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association la NONE Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI el NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Wolf Pen Creek Oversight Committee O Ron Gay O Chris Scotti Z1 NONE Describe each affiliation or bus ness 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 governmeit officer with whom filer has affiliation or business relationship. (Complete this section only if the answer to A, B, or C is YES. Lk1 i t 0' Coin r\ - t A. Is the local government o filer of the questionnaire? Yes icer named in this section receiving or likely to receive taxable income from the VI No B. Is the filer of the questionn ire receiving or likely to receive taxable income from or at the direction of the local government officer nam d in this section AND the taxable income is not from the local governmental entity? Yes No C. Is the filer of this questionniiire 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 J No business relationship. eu✓t�cccf Oe/Jut) JueceJildri elan V71,3 SD!J1C 3. 6. Signature of person doing busin ss with the governmental entity Date Adopted 01/13/06