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HomeMy WebLinkAboutO'Malley Engineers, L.L.P.CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ 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 commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. J Name of person doing business with local governmental entity. O'Malley Engineers, L.L.P. OFFICE USE ONLY Date Received x 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.) 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. O'Malley Engineers L.L.P. is an engineering firm that provides engineering services to the City of College Station. It has no other business affiliation with any local government officer, as defined by 176.001 of the Texas Local Government Code. 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 governmental entity that is the subject of this questionnaire. See response to No. 3 above. Amended 01/13/2006 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ Page 2 Name of local government officer with whom filer has affilitation or business relationship. (Complete this section only if the answer to A, B, or C is YES.) This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or business relationship. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? 11 Yes Ix1 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? 11 Yes X 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 1XI No D. Describe each affiliation or business relationship. N/A Describe any other affiliation or business relationship that might cause a conflict of interest. N/A Signature of person d ing business with the governmental entity Date Amended 01/13/2006 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ 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 commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. Name of person doing business with local governmental entity. O'Malley Engineers, L.L.P OFFICE USE ONLY Date Race ved Check this box if you we 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.) 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. O'Malley Engineers L.L.P. is an engineering firm that provides engineering services to the City of College Station. It has no other business affiliation with any local government officer, as defined by 176.001 of the Texas Local Government Code. 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 governmental entity that is the subject of this questionnaire. See response to No. 3 above. Amended 01/13/2006 CONFLICT OF I NTEREST QUESTIONNAIRE For vendor or other pe rson doing business with local governmental entity FORM CIQ Page 2 Name of local government officer with whom filer has affilitation or business relationship. (Complete this section only if the answer to A, B, or C is YES.) This section, item 5 including business relationship. Attach A. Is the local government o questionnaire? Yes subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or additional pages to this Form CIQ as necessary. cer named in this section receiving or likely to receive taxable income from the filer of the x No B. Is the filer of the questionn ire receiving or likely to receive taxable income from or at the direction of the local government officer named in this secti. AND the taxable income is not from the local governmental entity? Yes x No C. Is the filer of this questionn ire affiliated with a corporation or other business entity that the local government officer serves as an officer or director, or olds an ownership of 10 percent or more? Yes x No D. Describe each affiliation or business relationship. N/A Describe any other affiliation or business relationship that might cause a conflict of interest. N/A —17ll Signature of person oing business with the governmental entity to Amended 01/13/2006 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 commits 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 '2-07-06A10:50 RCVG J Name of person doing business with local governmental entity. O'Malley Engineers, L.L.P. E filing authority not later than Code, is pending and incomplete or inaccurate.) 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 September 1 of the year for which an activity described in Section 176.006(a), Local Government not later than the 7th business day after the date the originally filed questionnaire becomes 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. O'Malley Engineers L.L.P. is an engineering firm that provides engineering services to the City of College Station. It has no other business affiliation with any local government officer, as defined by 176.001 of the Texas Local Government Code. 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 governmental entity that is the subject of this questionnaire. See response to No. 3 above. Amended 01/13/2006 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ Page 2 Name of local government officer with whom filer has affilitation or business relationship. (Complete this section only if the answer to A, B, or C is YES.) This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has affiliation or business relationship. Attach additional pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? Yes X 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 X 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 X No D. Describe each affiliation or business relationship. N/A Describe any other affiliation or business relationship that might cause a conflict of interest. N/A ///06 Signature of person doing business with the governmental entity Date Amended 01!13/2006