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HomeMy WebLinkAboutAmerican Municipal ServicesCONFLICT 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 Cdde 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. 1. Name of person doing business with local governmental entity. 2d i 14 ✓1 I�'t v lx i C p)4 ( Sit U'� C es FORM CIQ 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. O Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney 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 O Charles McLemore, Public Works ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Asst. City Mgr ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. 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 'NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman ❑ Mary Fran Troy ❑ Jennifer Bohac ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Donald Braune O Dan B. Sears, Chairman O Mike Lane O Steve Parker, alternate B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Weldon Kruger 0 R Slocum RI/NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Don Scherr O B. Carroll Johnson LNON E ❑ Kevin Myers ❑ Joe Wallace O James Matson ❑ George McLean, Vice Chair 0 Frank Cox ❑ Larry D. Patton ❑/David Hart, alternate ❑ David Ruesink, alternate LK NONE ❑ Hillary Jessup, Chairman El Haskell Monre ❑ Ernie Wright NONE ❑ Rebecca Eplen ❑ Rusleen Maurice VNON E ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton NONE Historic Preservation Committee ❑ Bill Lancaster O Dipankar Sen ❑ Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ J. Kevin Byrne O Charlotte Mikulee Parks and Recreation Board El Kathleen Ireland ❑ Jody Ford ❑ Harry Green Planning and Zoning Commission ❑ John Nichols, Chair 0 Glenn Schroeder ❑ Marsha Sanford 0 Dennis Christiansen ❑ Harold Strong "NONE Design Review Board ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Deborah Deitering El Peggy Samson ❑ Joan Perry ❑ Gary Thomas El Gary Erwin ❑ Derek Dictson ❑ Bill Davis ❑ Rick Heany ❑ Hunter Goodwin 0 Nancy Sawtelle ❑ Alan King ❑ Ward Wells 0 John Nichols ❑ Susie Cox, alternate ❑ Robert Rayburn, alternate [ NONE ❑ Jay Goss, Chair ❑ penise Whisenant N7NONE Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ John Richards ❑ Thomas Mather Research Valley Partnership Board of Directors ❑ Larry Hodges ❑ Larry Mariott O Glenn Brown, City Manager NONE ❑ Sharon Colson, Chair ❑ Kenny Mallard Wolf Pen Creek TIF Board ❑ Chris Scotti, Councilman ❑ Marsha Sanford, Vice Chair ❑Marc Chaloupka ❑ James Massey Tr/NONE Outside Agency Funding Review ❑ Don Lewis ❑ Charles Taylor ❑ Gregg Baird ❑ Sheryl Welford O Chad Jones dNONE ❑ Roger Reese ❑ Carolyn Berrow 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 O Lynn McIlhaney 0 Ben White NONE Brazos Valley Council of Governments O Ron Silvia, Mayor /NONE B/CS Metropolitan Planning / Organization O Ron Silvia, Mayor 1J NONE BVCOG TMPA Regional Park Project Advisory Board O Lynn Mcllhaney IiNONE BVSWMA Policy Advisory Board / ❑ Ron Silvia, Mayor ❑ Chris Scotti 19' NONE City Center Committee ❑ Ron Silvia ❑ Ben White ❑ Dave Ruesink ENONE Intergovernmental Committee ❑ Ron Gay 0 Ben White 0 John Happ 1 (NONE ❑ Dave Ruesink El/NONE Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Dave Ruesink NONE Transportation Committee ❑ Ron Gay 0 John Happ ❑ Lynn Mcllhaney ❑ Ken Fogle 0 Linda LaSuit, MPO ❑ Dennis Christianson, TTI ❑ Michael Parker, BVCOG ❑ Bryan Woods, TxDOT C(NONE El Ron Gay Wolf Pen Creek Oversight Committee 0 Chris Scotti I/NONE E 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 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. /O -G -O Signature of person doing business with the governmental entity Date Adopted 01/13/06