HomeMy WebLinkAboutTechline, Ltd.CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
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.
OFFICE USE ONLY
Date Received
1. Name of person doing business with local governmental entity.
%4h 1 c ,LTA
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 ❑ Charles McLemore, Public Works
O Steve Beachy, Parks & Rec 0 Joey Dunn, Planning & Dev 0 Becky Nugent, Public Relations
O Glenn Brown, City Manager 0 Don Fazzino, Legislative Liason 0 Julie O'Connell, Human Resources
❑ Olivia Burnside, Inf. Tech. 0 Kim Foutz, Economic Dev 0 Mark Smith, Public Works
❑ Pete Caler, Landfill Mgr. 0 Connie Hooks, City Secretary 0 Ed Spillane, Municipal Judge
O Harvey Cargill, City Attorney 0ff Kersten, Finance 0 Cheryl Turney, Purchasing Mgr.
❑ John Woody, Utilities NI NONE
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
O Ron Gay, Place 3
O Nancy Berry, Place 6
City of College Station Elected Officials
College Station City Council
O Ben White, Place 1 0 John Happ, Place 2
O Susan Lancaster, Place 4 0 Chris Scotti, Place 5
it/NONE
City of College Station Committees, Boards, and Commissions
B/CS Library Committee
O Larry Ringer, Chairman 0 Katherine Edwards 0 Don Scherr
O Eric Miller 0 Jeanne Mitchell 0 Jo Berg
O Lois Koontz 0 James Bradford E NONE
Cemetery Committee
❑ Sarah Adams, Chair 0 Virginia Reese
O James Batenhorst 0 Mary Lind Bryan
O David Chester NONE
Construction Board of
Adjustments and
Appeals/Building & Standards
Commission
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
O Steve Parker, alternate 0 David Ruesink, alternate CI LONE
❑ Karen Kasper, Merchant
2 Joey Dunn, Dir. Planning & Dev
NONE
Facade Improvement Program
Advisory Committee
O Valerian Miranda, Architect 0 Rick Lemmons, Business Owner
❑ Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator
Historic Preservation Committee
❑ Hillary Jessup, Chairman ❑ Bill Lancaster
❑ Marguerite Anthony ❑ David Ruesink
❑ Thomas Taylor 0 ie Wright
O Colleen Risinger NONE
O Rebecca Eplen
❑ Rusleen Maurice
NONE
❑ Kathleen Ireland
❑ Carol Blaschke
O Jo Crompton
ONE
❑ Scott Shafer, Chairman
❑ Marsha Sanford
O Harold Strong
O Rick Heany
O Alan King
O Susie Cox, alternate
Joint Relief Funding Review
Committee
❑ J. Kevin Byrne
❑ Charlotte Mikulee
Parks and Recreation Board
❑ Glenn Schroeder
O Jeannie McCandless
O Harry Green
Planning and Zoning
Commission
O John Nichols
O Dennis Christiansen
V<ONE
Design Review Board
❑ Hunter Goodwin
❑ Ward Wells
O Robert Rayburn, alternate
❑ Marsha Crenwelge
❑ Dipankar Sen
❑ Neal Nutall, Jr.
O Mary Sherwood
O Peggy Samson
❑ Jodi Warner
❑ Gary Thomas
❑ Gary Erwin
O Ken Reynolds
O Bill Davis
O Nancy Sawtelle
O Scott Shafer
ONE
Zoning Board of Adjustments
❑ Jay Goss, Chair 0 Joshua Benn 0 John Richards
❑ Graham Sheffy 0 Donald Braune 0 Cl7les Taylor
O Denise Whisenant 0 Derek Dictson Gii'NONE
O David Hickson
O Glenn Brown, City Manager
O Sharon Colson, Chair
O Kenny Mallard
Research Valley Partnership
Board of Directors
O LL rry Mariott
Q NONE
Wolf Pen Creek TIF Board
0 Chris Scotti, Councilman
O Marsha Sanford, Vice Chair 0 M9a Chaloupka
O James Massey 0' 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
❑ Susan Lancaster 0 Nancy Berry Ci'NONE
Brazos Valley Council of
Governments Board of Directors
O Ron Silvia, Mayor 0 NONE
B/CS Metropolitan Planning
/ Organization
O Ron Silvia, Mayor ❑NONE
BVCOG TMPA Regional Park
Project Advisory Board
O Susan Lancaster NONE
BVSWMA Policy Advisory
Board
O Ron Silvia, Mayor 0 Susan Lancaster 13'NONE
❑ Ron Silvia
NONE
❑ Nancy Berry
E NONE
❑ Nancy Berry
E/NONE
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 0 John Happ
Sister Cities Association
O Ron Gay /NONE
O Ron Gay
O Linda LaSuit, MPO
O Bryan Woods, TxDOT
Transportation Committee
O John Happ
O DD,nnis Christianson, TTI
GVNONE
O Ken Fogle
❑ Michael Parker, BVCOG
Wolf Pen Creek Oversight
Committee
O Ron Gay
O Chris Scotti
O 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 s................_.,.�.. M,.M, �... ,...,..., .. ..
ection, 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.
Signature of person doing business with the governmental entity
-//(1/0(‘,
Date
Adopted 01/13/06