HomeMy WebLinkAboutRenegade Harley DavidsonCONFLICT 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.
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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
❑ NONE
❑ Michael Clancey, Police Chief
❑ Lance Simms, Planning & Dev
❑ John Woody, W/WW
❑ Terry Childers, Deputy City Mgr
❑ Connie Hooks, City Secretary
❑ Jeff Kersten, Chief Fin.Officer
❑ Becky Nugent, Public Relations
❑ Julie O'Connell, Human Resources
❑ Mark Smith, Public Works
❑ Ed Spillane, Municipal Judge
❑ Cheryl Turney, Purchasing Mgr.
❑ David Massey, Electric
Describe each affiliation or business relationship with an employee checked in Question 3 above:
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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
O Ron Gay, Place 3
❑ David Ruesink, Place 6
City of College Station Elected Officials
College Station City Council
El Ben White, Place 1
❑ Lynn McIlhaney, Place 4
❑ NONE
❑ John Happ, Place 2
❑ Chris Scotti, Place 5
City of College Station Committees, Boards, and Commissions
❑ Larry Ringer, Chairman
❑ Mary Fran Troy
❑ Jennifer Bohac
❑ Sarah Adams, Chair
❑ James Batenhorst
❑ David Chester
❑ Donald Braune
❑ Dan B. Sears, Chairman
El Mike Lane
El Steve Parker, alternate
0 NONE
B/CS Library Committee
O Katherine Edwards
❑ Jeanne Mitchell
❑ James Bradford
Cemetery Committee
❑ Virginia Reese
❑ Weldon Kruger
❑ RC Slocum
El NONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
❑ Frank Cox
❑ Larry D. Patton
❑ Glenn Thomas, alternate
❑ Don Scherr
❑ B. Carroll Johnson
❑ NONE
❑ Kevin Myers
El Joe Wallace
❑ James Matson
❑ David Hart
❑ Charles Thomas, alternate
O Quinn Williams
❑ Hillary Jessup, Chairman
❑ Haskell Monre
❑ Ernie Wright
❑ NONE
❑ Rebecca Eplen
❑ Rusleen Maurice
❑ NONE
❑ Jodi Warner, Chair
❑ Shawn Rhodes
❑ John Crompton
❑ NONE
❑ John Nichols, Chair
❑ Marsha Sanford
❑ Harold Strong
❑ Rick Heany
❑ Alan King
❑ Susie Cox, alternate
❑ Jay Goss, Chair
❑ Denise Whisenant
❑ NONE
Historic Preservation Committee
❑ Bill Lancaster
❑ Dipankar Sen
O Neal Nutall, Jr.
Joint Relief Funding Review
Committee
O J. Kevin Byrne
O Charlotte Mikulee
Parks and Recreation Board
❑ Kathleen Ireland
O Jody Ford
❑ Harry Green
Planning and Zoning
Commission
❑ Glenn Schroeder
❑ Dennis Christiansen
❑ NONE
Design Review Board
❑ Hunter Goodwin
❑ Ward Wells
❑ Robert Rayburn, alternate
Zoning Board of Adjustments
❑ Joshua Benn
❑ Donald Braune
ae
❑ Marguerite Anthony
❑ Thomas Taylor
❑ Colleen Risinger
❑ Deborah Deitering
❑ Peggy Samson
❑ Joan Perry
❑ Gary Thomas
O Gary Erwin
❑ Derek Dictson
❑ Bill Davis
❑ Nancy Sawtelle
❑ John Nichols
❑ NONE
❑ John Richards
❑ Thomas Mather
❑ Larry Hodges
❑ Glenn Brown, City Manager
❑ Sharon Colson, Chair
❑ Kenny Mallard
❑ Don Lewis
❑ Gregg Baird
O Chad Jones
❑ Stephen Syptak, Chair
❑ Tom Kirkland
❑ NONE
❑ Hugh Lindsay, Area I
❑ John Crompton, Area 1I
❑ Steve Arden, Area III
❑ Hugh Stearns, Area IV
❑ Andrew Burleson, Student Resident
O Dorthea Robinson, Alternate,
ETJ Resident
O Chris Scotti, Councilmember
Research Valley Partnership
Board of Directors
❑ Larry Mariott
❑ NONE
Wolf Pen Creek TIF Board
❑ Marsha Sanford, Vice Chair
❑ James Massey
Outside Agency Funding Review
❑ Charles Taylor
❑ Sheryl Welford
❑ NONE
Northgate Tax Increment
Finance Board
O David Scarmardo
O Glenn Thomas
Comprehensive Plan Committee
❑ John Richards, Area I
❑ Brian Bochner, Area II
❑ Laurie Corbelli, Area III
❑ Jerry Cooper, Area IV
❑ Kristina Campbell, Alternate,
Student Resident
O Craig Hall, Resident -At -Large
Cl Lynn Mcllhaney, Alternate,
Councilmember
60114
0 Chris Scotti, Councilman
❑ Marc Chaloupka
0 NONE
❑ Roger Reese
O Carolyn Berrow
❑ Anne Jackson
❑ Dale O'Riley
O David Hart, Alternate, Area I
❑ Dennis Corrington, Alternate, Area II
❑ Tom Taylor, Alternate, Area III
❑ Adrian Williams, Alternate, Area IV
❑ Douglas Rape', ETJ Resident
❑ Mike Guido, Alternate,
Resident -At -Large
O 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
❑ Lynn McIlhaney
❑ Ron Silvia, Mayor
❑ Ron Silvia, Mayor
❑ Lynn McIlhaney
❑ Ron Silvia, Mayor
❑ Ron Silvia
O NONE
❑ Ron Gay
0 NONE
❑ Ben White ❑ NONE
Brazos Valley Council of
Governments
❑ NONE
B/CS Metropolitan Planning
Organization
0 NONE
BVCOG TMPA Regional Park
Project Advisory Board
0 NONE
BVSWMA Policy Advisory
Board
El Chris Scotti
City Center Committee
❑ Ben White
Intergovernmental Committee
0 Ben White
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0 NONE
❑ Dave Ruesink
❑ John Happ
❑ Dave Ruesink
❑ NONE
Joint City/School
Intergovernmental Committee
0 Ben White ❑ John Happ
Sister Cities Association
❑ Dave Ruesink ❑ NONE
❑ Ron Gay
O Ken Fogle
❑ Michael Parker, BVCOG
0 Ron Gay
Transportation Committee
❑ John Happ
❑ Linda LaSuit, MPO
❑ Bryan Woods, TxDOT
Wolf Pen Creek Oversight
Committee
❑ Chris Scotti
❑ Lynn Mcllhaney
❑ Dennis Christianson, TTI
❑ NONE
0 NONE
Describe each affiliation or business relationship with an employee checked in Question 4 above:
Adopted 01/13/06
CONFLICT OF INTEREST QUESTIONNAIRE
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 C1Q 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.
FORM CIQ
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.
Signature of person doing business with the governmental entity Date
Adopted 01/13/06