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HomeMy WebLinkAboutRambin, DavidCONFLICT 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. 1) Av 1 D TAK5114 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 ❑ 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 ❑ Jeff Kersten, Finance IRKONE ❑ 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 ❑ Sasan Lancaster, Place 4 NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Eric Miller ❑ Lois Koontz B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Sarah Adams, Chair ❑ Virginia Reese ❑ James Batenhorst ❑/Mary Lind Bryan ❑ David Chester [5a' NONE ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev Q'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 ❑ Valerian Miranda, Architect ❑ Robert Mosley, City Engineer ❑ Don Scherr ❑ Jo Berg NONE ❑ Kevin Myers ❑ Joe Wallace ❑ Frank Cox ❑ D�vid Hart, alternate f ' NONE ❑ Rick Lemmons, Business Owner ❑ Eric Barton, CD Coordinator Historic Preservation Committee ❑ Hillary Jessup, Chairman El Bill Lancaster ❑ Marguerite Anthony El David Ruesink ❑ Thomas Taylor El E,.ie Wright El Colleen Risinger [V ONE ❑ Rebecca Eplen ❑ Rusleen Maurice I <ONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton ONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne El Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder El Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ Scott Shafer, Chairman ❑ John Nichols El Marsha Sanford ❑l Dennis Christiansen El Harold Strong � NONE Design Review Board ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood El Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds 0 Bill Davis ❑ Rick Heany ❑ Hunter Goodwin ❑ Nancy Sawtelle ❑ Alan King ❑ Ward Wells ❑ Scott Shafer ❑ Susie Cox, alternate El Robert Rayburn, alternate NONE Zoning Board of Adjustments ❑ Jay Goss, Chair El Joshua Benn ❑ John Richards ❑ Graham Sheffy El Donald Braune ❑ 9arles Taylor 0 Denise Whisenant 0 Derek Dictson S'NONE Research Valley Partnership Board of Directors ❑ David Hickson ❑ Larry Mariott ❑ Glenn Brown, City Manager [DVKONE ❑ Sharon Colson, Chair ❑ Kenny Mallard Wolf Pen Creek TIF Board ❑ Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair ❑ Myc Chaloupka ❑ James Massey [�YNONE "I'he 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 Brazos County Health Department ❑ Nancy Berry ['NONE Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayor NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor DONE BVCOG TMPA Regional Park Project Advisory Board ❑ Susan Lancaster p N ONE BVSWMA Policy Advisory Board ❑ Ron Silvia, Mayor ❑ Susan LancasterNONE O� Silvia di NONE O Ncy Berry X84 ONE O Nancy Berry L 4 ONE City Center Committee O Ben White 0 Nancy Berry Intergovernmental Committee O Ben White 0 John Happ Joint City/School Intergovernmental Committee O Ben White ❑ John Happ Sister Cities Association O Ron Gay [k NONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee ❑ John Happ O Dennis Christianson, TTI NONE ❑ Ken Fogle 0 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 Fonn 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 t is 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 diretor, or holds an ownership of 10 percent or more? Yes D. Describe each affiliation or business relationship. 6. X27° -c Signature of person doing business with the governmental entity Date Adopted 01/13/06