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HomeMy WebLinkAboutUnited Rentals Highway Technologies, L.P.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. I. Name of person doing business with local governmental entity. OFFICE USE ONLY Date Received Uukt&. (�.�tals (�1waa. Technolc,esI—] , L.�'.. 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. ❑ Glenn Brown, City Manager ❑ Robert Alley, Fire Chief ❑ Pete Caler, Landfill Mgr. ❑ David Gwin, Economic Dev. ❑ David Massey, Electric ❑ Lance Simms, Planning & Dev ❑ Cheryl Turney, Purchasing Mgr. O Terry Childers, Deputy City Mgr O Steve Beachy, Parks & Rec O Harvey Cargill, City Attorney ❑ Connie Hooks, City Secretary ❑ Becky Nugent, Public Relations ❑ Mark Smith, Public Works ❑ John Woody, W/WW ❑. Kathy Merrill, Asst. City Mgr. ❑ Olivia Burnside, Inf. Tech. ❑ Michael Clancey, Police Chief ❑ Jeff Kersten, Chief Fin.Officer ❑ Julie O'Connell, Human Resources ❑ Ed Spillane, Municipal Judge I/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 ❑ Ron Gay, Place 3 ❑ David Ruesink, Place 6 City of College Station Elected Officials College Station City Council ❑ Ben White. Place I ❑ Lynn Mcllhaney, Place 4 [2'.. -NONE ❑ John l Lapp, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions El Larry Ringer, Chairman ❑ Mary Fran Troy ❑ Jennifer Bohac ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Donald Braune ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑/Steve Parker. alternate ©NONE B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese O Weldon Kruger ❑ RC Slocum I3'NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Frank Cox O Larry D. Patton ❑ Glenn Thomas, alternate ❑ Don Scherr ❑ B. Carroll Johnson Lh NON E ❑ Kevin Myers ❑ Joe Wallace ❑ James Matson ❑ David Hart El Charles Thomas, alternate ❑ Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright 6MNONE ❑ Rebecca Eplen ❑ Rusleen Maurice 'NONE O Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton d NONE ❑ John Nichols, Chair ❑ Marsha Sanford O Harold Strong Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey ❑ Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulec Parks and Recreation Board ❑ Kathleen Ireland ❑ Jody Ford ❑ Harry Green Planning and Zoning Commission ❑ Glenn Schroeder 0Dennis Christiansen [1NONE Design Review Board ❑ Marguerite Anthony O Meredith Waller ❑ Colleen Risinger ❑ Deborah Deitering ❑ Peggy Samson ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin ❑ Derek Dictson ❑ Bill Davis ❑ Rick Heany ❑ Hunter Goodwin ❑ Nancy Sawtelle ❑ Alan King ❑ Ward Wells ❑ John Nichols ❑ Susie Cox, alternate ❑ Robert Rayburn, alternate Isd NONE O Jay Goss, Chair O Denise Whisenant I(NONE Zoning Board of Adjustments ❑ Joshua Benn O Donald Braune ❑ John Richards O Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird ❑ Chad Jones • ❑ Stephen Syptak, Chair ❑/Tom Kirkland 67NONE ❑ Hugh Lindsay, Area I O John Crompton, Area Il ❑ Steve Arden, Area III ❑ Hugh Stearns, Area IV ❑ Andrew Burleson, Student Resident ❑ Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember ❑ Hillary Jessup, Historic Preservation ❑ Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors ❑ Larry Marion IONONE 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 ❑ David Scarmardo O Glenn Thomas Comprehensive Plan Committee ❑ John Richards, Area I ❑ Brian Bochner, Area II ❑ Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV O Kristina Campbell, Alternate, Student Resident ❑ Craig Hall, Resident -At -Large ❑ Lynn Mcllhaney, Alternate, Councilmember ❑ Gary Erwin, Parks & Rec ❑ Larry Haskins, Northgate District Assoc. ❑ Chris Scotti, Councilman ❑ Marc Chaloupka NONE ❑ Roger Reese ❑ Carolyn Berrow O Anne Jackson O Dale O'Riley ❑ 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 ❑ Bill Davis, P&Z ❑ Kathleen Ireland, Parks & Rec Alternate ❑ Bo Miles, Building & Land Development ❑ Larry Marriott, Home Builders Assoc. ❑ Tedi Ellison, Intergovernmental Comm/Chamber of Commerce ❑ James Massey, Intergovernmental Comm/TAMU Admin ❑ Dr. Clark Ealy, Intergovernmental Comm/CSISD ❑ Chuck Martinez. Intergovernmental Comm/ Research Valley Patnership ❑ Linda LaSut, Intergovernmental Comm/MPO ❑ Lindsey Guindi, Intergovernmental Comm/Chamber of Commerce ❑ Rodney Weis, Intergovernmental Comm/TAMU Transit ❑ Dr. Colleen Netterville, Intergovernmental Comm/BISD O Margie Lucas, Intergovernmental Comm/ Brazos Transit District O Chad Bohne. Intergovernmental CommrrxDOT ❑ Michael Parks, Intergovernmental Comm/BVCOG ❑ Gary Arnold, Intergovernmental Comm/Brazos County Sheriff ❑ Gary Teston, Intergovernmental Comm/ Easterwood Airport Et/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 Mcllhaney ❑ Ben White (g NONE Brazos Valley Council of Governments ❑ Ron Silvia, Mayor I 'NONE B/CS Metropolitan Planning iNONE ❑ Ron Silvia. Mayor a NONE BVCOG TMPA Regional Park Project Advisory Board / O Lynn Mcllhaney II NONE BVSWMA Policy Advisory Board O Ron Silvia, Mayor 0 Chris Scotti I/NONE City Center Committee O Ron Silvia ❑ Ben White ❑ Dave Ruesink RI NONE Intergovernmental Committee ❑ Ron Gay LI Ben White ❑ John Rapp NONE ❑ Dave Ruesink VNONE ❑ Dave Ruesink Joint City/School Intergovernmental Committee 0 Ben White 0 John Ilapp Sister Cities Association /NONE Transportation Committee ❑ Ron Gay ❑ John Flapp 0 Lynn Mcllhaney ❑ Ken Fogle ❑ Linda LaSuit, MPO 0 Dennis Christianson, TTI ❑ Michael Parker, BVCOG ❑ Bryan Woods, TxDOT iceNONE ❑ Ron Gay Wolf Pen Creek Oversight Committee 0 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 For vendor or other person doing business with local governmental entity This section, item 5 including subparts A. B, C & I), must be completed for each officer with Nvhom the filer has affiliation or other relationship. Attach additional pages to this Form CIQ as necessary. FORM CIQ 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 go9ernmental entity o� Date Adopted 01/13/06