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HomeMy WebLinkAboutAcklam ConstructionCONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ his 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. Ae -,44s4-4 601U5T7zoe c)14 t t- 1P 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 -tot 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 ❑ Bob Cowell, Planning & Dev ❑ Cheryl Turney, Purchasing Mgr. ❑ Terry Childers, Deputy City Mgr itg Steve Beachy, Parks & Rec ❑ Harvey Cargill, City Attorney ❑ Connie Hooks, City Secretary ❑ Becky Nugent, Public Relations ❑ Mark Smith, Public Works ❑ Dave Coleman, W/WW ❑ Kathy Merrill, Asst. City Mgr. ❑ Ben Roper, Inf. Tech. ❑ Michael Clancey, Police Chief ❑ Jeff Kersten, Chief Fin.Officer ❑ Julie O'Connell, Human Resources ❑ Ed Spillane, Municipal Judge ❑ NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: 7Q14.1.) L:1-4bA, £7p 'eel C.-�.� /`''1.4-T G7lz ..JO1 ? 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. O Ron Silvia, Mayor El Ron Gay, Place 3 O David Ruesink, Place 6 City of College Station Elected Officials College Station City Council O Ben White, Place 1 O Lynn Mcllhaney, Place 4 NONE O John Happ, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman O Mary Fran Troy O Sonio Margarita Gangotena O Sarah Adams, Chair CI James Batenhorst O David Chester 0 Donald Braune O Dan B. Sears, Chairman El Mike Lane O Steve Parker, alternate NONE B/CS Library Committee O Katherine Edwards O Jeanne Mitchell O James Bradford Cemetery Committee El Virginia Reese O Weldon Kruger O RC Slocum NONE Construction Board of Adjustments and Appeals/Building & Standards Commission O Frank Cox Larry D. Patton 0 Glenn Thomas, alternate 0 Don Scherr O B. Carroll Johnson ,a4 NONE O Kevin Myers 0 Joe Wallace El James Matson 0 David Hart 0 Charles Thomas, alternate Ell Quinn Williams Ell Hillary Jessup, Chairman CI Haskell Monroe ED Ernie Wright )4 NONE Historic Preservation Committee 0 Bill Lancaster 0 Jane Hughey 0 Neal Nutall, Jr. Joint Relief Funding Review Committee 0 Marguerite Anthony O Meredith Waller O Colleen Risinger 0 Tedi Ellison 0 J. Kevin Byrne 0 Deborah Deitering O Rusleen Maurice 0 Reba Ragdale 0 NONE O Jodi Warner, Chair 0 Shawn Rhodes O John Crompton )4 NONE 0 John Nichols, Chair O Marsha Sanford CI Harold Strong Parks and Recreation Board 0 Kathleen Ireland 0 Jody Ford 0 Harry Green Planning and Zoning Commission CI Joan Perry CI Gary Thomas Ci Gary Erwin 0 Glenn Schroeder CI Derek Dictson 0 Dennis Christiansen 0,IA NONE Design Review Board O Bill Davis O Rick Heaney 0 Hunter Goodwin 0 Nancy Sawtelle 0 Alan King /4 Ward Wells 0 John Nichols 0 Susie Cox, alternate 0 Robert Rayburn, alternate El NONE O Jay Goss, Chair O Denise Whisenant O NONE Zoning Board of Adjustments 0 Joshua Benn 0 Donald Braune O John Richards O Thomas Mather El Larry Hodges El Glenn Brown, City Manager O Sharon Colson, Chair 0 Kenny Mallard O Don Lewis O Gregg Baird O Chad Jones O Stephen Syptak, Chair El Tom Kirkland O NONE O Hugh Lindsay, Area I O John Crompton, Area II O Steve Arden, Area III CI Hugh Stearns, Area IV O Andrew Burleson, Student Resident UI Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation O Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors 11:1 Larry Mariott O NONE Wolf Pen Creek TIE Board O Marsha Sanford, Vice Chair O James Massey Outside Agency Funding Review 0 Charles Taylor O Sheryl Welford O NONE Northgate Tax Increment Finance Board O David Scarmardo El Glenn Thomas Comprehensive Plan Committee O John Richards, Area I O Brian Bochner, Area II CI Laurie Corbelli, Area III O Jerry Cooper, Area IV O Kristina Campbell, Alternate, Student Resident 0 Craig Hall, Resident -At -Large 1:11 Lynn Mcllhaney, Alternate, Councilmember [11 Gary Erwin, Parks & Rec O Larry Haskins, Northgate District Assoc. El Chris Scotti, Councilman 0 Marc Chaloupka Ell NONE O Roger Reese O Carolyn Berrow Cl Anne Jackson El Dale O'Reiley O David Hart, Alternate, Area I O Dennis Corrington, Alternate, Area H Ell Tom Taylor, Alternate, Area III CI Adrian Williams, Alternate, Area 1V 111 Douglas Rape', ETJ Resident 0 Mike Guido, Alternate, Resident -At -Large 0 Bill Davis, P&Z O Kathleen Ireland, Parks & Rec Alternate El Bo Miles, Building & Land Development El Larry Marriott, Home Builders Assoc. O Tedi Ellison, Intergovernmental Comm/Chamber of Commerce CI James Massey, Intergovernmental Comm/TAMU Admin O Dr. Clark Ealy, Intergovernmental Comm/CSISD O Chuck Martinez, Intergovernmental Comm/ Research Valley Patnership O Linda LaSut, Intergovernmental Comm/MPO O Lindsey Guindi, Intergovernmental Comm/Chamber of Commerce O Rodney Weis, Intergovernmental Comm/TAMU Transit O Dr. Colleen Netterville, Intergovernmental Comm/BISD O Margie Lucas, Intergovernmental Comm/ Brazos Transit District 0 Chad Bohne, Intergovernmental Comm/TxDOT 0 Michael Parks, Intergovernmental Comm/BVCOG 0 Gary Arnold, Intergovernmental Comm/Brazos County Sheriff 0 Gary Teston, Intergovernmental Comm/ Easterwood Airport 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. LI Lynn Mcllhaney 0 Ron Silvia, Mayor O Ron Silvia, Mayor El Lynn Mcllhaney O Ron Silvia, Mayor O Ron Silvia 0 NONE O Ron Gay NONE Brazos County Health Department 0 Ben White P NONE Brazos Valley Council o Governments fY4 NONE B/CS Metropolitan Planning Organization IA NONE BVCOG TMPA Regional Park Project Advisory Board NONE BVSWMA Policy Advisory Board El Chris Scotti City Center Committee NONE El Ben White El Dave Ruesink Intergovernmental Committee LI Ben White ED John Happ L1 Dave Ruesink NONE Joint City/School Intergovernmental Committee O Ben White 0 John Happ Sister Cities Association O Dave Ruesink ;RI NONE O Ron Gay O Ken Fogle O Michael Parker, BVCOG O Ron Gay O John Nichols O Joan Perry Transportation Committee O John Happ O Linda LaSuit, MPO O Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee O Chris Scotti O Marsha Sanford O Sharon Colson O Lynn Mcllhaney O Dennis Christianson, TTI NONE O Marc Chaloupka O Jodi Warner NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: Lo4€42.1 PdArrac, /4-1 4772P --42e.. 17,[217-7- 12116 L. • P. IdA-17-D 146-16-1-1(2firl Ix) it,141,17-7,414-T t?f-bi::)101 1176-J. 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 as 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. Signa e of person doing business with the governmental entity -S i. t1 , 20.12 '-7 Date L . Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity an• 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. s e•OPIPAt417:' 2. FORM CIQ OFFICE USE ONLY Date Received 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.) M.E.Mdf.....W..M.L.IIMMWV*I.M4,4•61.4411•WW1 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. 0 Glenn Brown, City Manager O Robert Alley, Fire Chief O Pete Caler, Landfill Mgr. O David Gwin, Economic Dev, O David Massey, Electric O Lance Simms, Planning & Dev CherylLI Turney, Purchasing Mgr. O Terry Childers, Deputy City Mgr Steve Beachy, Parks & Rec 0 Harvey Cargill, City Attorney O Connie Hooks, City Secretary O Becky Nugent, Public Relations 0 Mark Smith, Public Works O John Woody, W/WW 0 Kathy Merrill, Asst. City Mgr. O Olivia Burnside, Inf. Tech. O Michael Clancey, Police Chief O Jeff Kersten, Chief Fin.Officer O Julie O'Connell, Human Resources O Ed Spillane, Municipal Judge O NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: 7-44-4Z7 Z-1-411-196 OF '10/ Gl..4-1961•-1.467e Cr- JAL) 41-/Z-/-41-fri 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. O Ron Silvia, Mayor O Ron Gay, Place 3 El David Ruesink, Place 6 City of College Station Elected Officials College Station City Council O Ben White, Place 1 O Lynn Mcllhaney, Place 4 114 NONE O John Happ, Place 2 LI Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions B/CS Library Committee Cl Larry Ringer, Chairman 0 Katherine Edwards 0 Don Scherr O Mary Fran Troy 0 Jeanne Mitchell 0 B. Carroll Johnson O Sonio Margarita Gangotena 0 James Bradford ;If NONE 0 Sarah Adams, Chair O James Batenhorst O David Chester O Donald Braune O Dan B. Sears, Chairman 0 Mike Lane O Steve Parker, alternate NONE Cemetery Committee O Virginia Reese El Weldon Kruger O RC Slocum NONE Construction Board of Adjustments and Appeals/Building & Standards Commission 0 Frank Cox fi Larry D. Patton O Glenn Thomas, alternate O Kevin Myers 0 Joe Wallace O James Matson • 0 David Hart O Charles Thomas, alternate O Quinn Williams LI Hillary Jessup, Chairman O Haskell Monroe 0 Ernie Wright NONE Historic Preservation Committee O Bill Lancaster 0 Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee 0 Marguerite Anthony O Meredith Waller O Colleen Risinger O Tedi Ellison 0 J. Kevin Byrne 0 Deborah Deitering O Rusleen Maurice 0 Reba Ragdale 0 )14 NONE O Jodi Warner, Chair O Shawn Rhodes O John Crompton NONE Li John Nichols, Chair 0 Marsha Sanford 0 Harold Strong O Rick Heaney O Alan King O Susie Cox, alternate 0 Jay Goss, Chair O Denise Whisenant 0 NONE Parks and Recreation Board Li Kathleen Ireland O Jody Ford CI Harry Green Planning and Zoning Commission 0 Glenn Schroeder 0 Dennis Christiansen fi 1 NONE Design Review Board O Hunter Goodwin Ward Wells CI Robert Rayburn, alternate O Joan Perry O Gary Thomas O Gary Erwin 0 Derek Dictson O Bill Davis CI Nancy Sawtelle O John Nichols O NONE Zoning Board of Adjustments O Joshua Berm Li John Richards 0 Donald Braune 0 Thomas Mather LI Larry Hodges O Glenn Brown, City Manager O Sharon Colson, Chair CI Kenny Mallard O Don Lewis O Gregg Baird O Chad Jones O Stephen Syptak, Chair O Tom Kirkland O NONE O Hugh Lindsay, Area I O John Crompton, Area II O Steve Arden, Area III O Hugh Stearns, Area IV 0 Andrew Burleson, Student Resident O Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation 0 Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors O Larry Marion O NONE Wolf Pen Creek TIF Board O Marsha Sanford, Vice Chair O James Massey Outside Agency Funding Review O Charles Taylor 0 Sheryl Welford O NONE Northgate Tax Increment Finance Board O David Scarmardo O Glenn Thomas Comprehensive Plan Committee CI John Richards, Area I 0 Brian Bochner, Area II O Laurie Corbelli, Area III 0 Jerry Cooper, Area IV CI Kristina Campbell, Alternate, Student Resident O Craig Hall, Resident -At -Large 0 Lynn Mcllhaney, Alternate, Councilmember O Gary Erwin, Parks & Rec O Larry Haskins, Northgate District Assoc. O Chris Scotti, Councilman O Marc Chaloupka O NONE CI Roger Reese 0 Carolyn Berrow O Anne Jackson O Dale O'Reiley O David Hart, Alternate, Area I O Dennis Corrington, Alternate, Area II O Tom Taylor, Alternate, Area III O Adrian Williams, Alternate, Area IV LI Douglas Rape', ETJ Resident 0 Mike Guido, Alternate, Resident -At -Large CI Bill Davis, P&Z O Kathleen Ireland, Parks & Rec Alternate 0 Bo Miles, Building & Land Development ❑ Larry Marriott, Home Builders Assoc. O Tedi Ellison, Intergovernmental Comm/Chamber of Commerce ❑ James Massey, Intergovernmental Comm/TAMU Admin O 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 ❑ Margie Lucas, Intergovernmental Comm/ Brazos Transit District O Chad Bohne, Intergovernmental Comm/TxDOT O Michael Parks, Intergovernmental CommBVCOG O Gary Arnold, Intergovernmental Comm/Brazos County Sheriff O Gary Teston, Intergovernmental Comm/ Easterwood Airport A 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 O Lynn Mcllhaney 0 Ben White NONE Brazos Valley Council of Governments O Ron Silvia, Mayor al NONE B/CS Metropolitan Planning Organization 0 Ron Silvia, Mayor 12! NONE BVCOG TMPA Regional Park Project Advisory Board O Lynn Mcllhaney „0 NONE BVSWMA Policy Advisory Board 0 Ron Silvia, Mayor 0 Chris Scotti NONE City Center Committee O Ron Silvia 0 Ben White 0 Dave Ruesink 0 NONE Intergovernmental Committee CI Ron Gay 0 Ben White 0 John Happ 1$ NONE Li Dave Ruesink NONE Joint City/School Intergovernmental Committee O Ben White 0 John Happ Sister Cities Association O Dave Ruesink )91 NONE O Ron Gay O Ken Fogle O Michael Parker, BVCOG O Ron Gay 0 John Nichols O Joan Perry Transportation Committee O John Happ O Linda LaSuit, MPO O Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee O Chris Scotti O Marsha Sanford O Sharon Colson O Lynn Mcllhaney O Dennis Christianson, TTI JS4 NONE O Marc Chaloupka O Jodi Warner ,21 NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: 1.04(42-1. PlArT120 — t:?-772MeS-PQP— sgekE— (2,12rrr L1-befizil. L.P. &S4IZE) W A6-1171.-Irbki2, A,141,177,41(-- .512(bPiliY 1L7/4. Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ 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 74 No D. Describe each affiliation or business relationship. 6. ,4)1&T At? 2a)e7 ure of person doing business with the governmental entity Date ogee -L414%4 442,-1.5742viriON ea7MP"4644Y Adopted 01/13/06 CONFLICT 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. 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. ❑ 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. ❑ Terry Childers, Deputy City Mgr Steve Beachy, Parks & Rec ❑ Harvey Cargill, City Attorney ❑ Connie Hooks, City Secretary ❑ Becky Nugent, Public Relations ❑ Mark Smith, Public Works O John Woody, W/WW ❑ Kathy Merrill, Asst. City Mgr. ❑ Olivia Burnside, Inf. Tech. ❑ Michael Clancey, Police Chief ❑ JeffKersten, Chief Fin.Officer ❑ Julie O'Connell, Human Resources ❑ Ed Spillane, Municipal Judge ❑ NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: TA—/v -- L111.12S QF c4.4 -‘,61-1.67e JA0 4414404-1 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 l ❑ Lynn Mcllhaney, Place 4 jg NONE ❑ John Happ, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Mary Fran Troy ❑ Sonio Margarita Gangotena O Sarah Adams, Chair O James Batenhorst ❑ David Chester ❑ Donald Braune ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate NONE B/CS Library Committee ❑ Katherine Edwards ❑ Don Scherr ❑ Jeanne Mitchell ❑ B. Carroll Johnson ❑ James Bradford jg NONE Cemetery Committee ❑ Virginia Reese ❑ Weldon Kruger ❑ RC Slocum NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Frank Cox Larry D. Patton ❑ Glenn Thomas, alternate O Kevin Myers El Joe Wallace O James Matson O David Hart O Charles Thomas, alternate O Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright iA NONE Historic Preservation Committee Cl Bill Lancaster ❑ Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ Marguerite Anthony ❑ Meredith Waller ❑ Colleen Risinger ❑ Tedi Ellison 0 J. Kevin Byrne ❑ Deborah Deitering ❑ Rusleen Maurice ❑ Reba Ragdale ❑ "A NONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton jki NONE ❑ John Nichols, Chair ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heaney ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Denise Whisenant 0 NONE Parks and Recreation Board ❑ Kathleen Ireland ❑ Jody Ford O Harry Green Planning and Zoning Commission ❑ Glenn Schroeder ❑ Dennis Christiansen NONE Design Review Board ❑ Hunter Goodwin Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin ❑ Derek Dictson O Bill Davis ❑ Nancy Sawtelle ❑ John Nichols O NONE ❑ John Richards ❑ Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird ❑ Chad Jones ❑ Stephen Syptak, Chair ❑ Tom Kirkland O NONE ❑ Hugh Lindsay, Area I O John Crompton, Area II ❑ Steve Arden, Area III ❑ Hugh Stearns, Area IV ❑ Andrew Burleson, Student Resident ❑ Dorthea Robinson, Alternate, ETJ Resident ❑ Chris Scotti, Councilmember Cl Hillary Jessup, Historic Preservation ❑ Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors ❑ Larry Mariott ❑ NONE 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 Cl John Richards, Area I ❑ Brian Bochner, Area II O Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ 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 ❑ Anne Jackson El Dale O'Reiley ❑ David Hart, Alternate, Area I ❑ Dennis Corrington, Alternate, Area I! ❑ Tom Taylor, Alternate, Area III ❑ Adrian Williams, Alternate, Area IV ❑ Douglas Rape', ETJ Resident ❑ Mike Guido, Alternate, Resident -At -Large O Bill Davis, P&Z O 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/CS ISD ❑ 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 ❑ Margie Lucas, Intergovernmental Comm/ Brazos Transit District ❑ Chad Bohne, Intergovernmental Comm/TxDOT ❑ Michael Parks, Intergovernmental CommBVCOG ❑ Gary Arnold, Intergovernmental Comm/Brazos County Sheriff ❑ Gary Teston, Intergovernmental Comm/ Easterwood Airport A 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 0 Ben White , NONE Brazos Valley Council of Governments 0 Ron Silvia, Mayor .541 NONE B/CS Metropolitan Planning Organization 0 Ron Silvia, Mayor J4 NONE BVCOG TMPA Regional Park Project Advisory Board 0 Lynn Mcllhaney NONE 0 Ron Silvia, Mayor ❑ Ron Silvia 5if NONE 0 Ron Gay pi NONE BVSWMA Policy Advisory Board 0 Chris Scotti City Center Committee 0 Ben White Intergovernmental Committee 0 Ben White RP NONE ❑ Dave Ruesink 0 John Happ ❑ Dave Ruesink X NONE Joint City/School Intergovernmental Committee ❑ Ben White 0 John Happ Sister Cities Association ❑ Dave Ruesink NONE ❑ Ron Gay ❑ Ken Fogle ❑ Michael Parker, BVCOG ❑ Ron Gay ❑ John Nichols ❑ Joan Perry Transportation Committee ❑ John Happ ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee ❑ Chris Scotti ❑ Marsha Sanford ❑ Sharon Colson ❑ Lynn Mcllhaney ❑ Dennis Christianson, TTI NONE ❑ Marc Chaloupka ❑ Jodi Warner NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: P� 11711-J ,e. !g!6 GJ Le1btar, — 1 1C ,1 1g /4 J 46 l7m k ' lbP&v'/ 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. .a4s41.7417r Zee 2010 f person doing business with the governmental entity Date ,d. to4isr g7ON LQ 1F%i » tom . Adopted 01/13/06 CERTIFICATION CERTIFICATION OF BID The undersigned affirms that they are duly authorized to execute this contract, that this bid has not been prepared in collusion with any other bidder, and that the contents of this bid have not been communicated to any other bidder prior to the official opening of this bid. Additionally, the undersigned affirms that the firm is willing to sign the enclosed SFfAiin� auta applicable 11 MANAGEMENT, GP, LLC, GENERAL Signed :, '� . Q.t �•-+�--- Title: MINER OF ACILJIM CONSTRUCTION COM 1Nv, LTD. ,ate. -i c4242sTP-vgro/J Typed -1p1.1 N• Q4e-44/1 Company Name: GatiF7417tr; L. Phone No.: 6999) 6 9D - SOW Fax No.: 69'79) Email: Jau 462,44spzoc c7,0 .ea2m Bid Address: /b9 32 S. 14. S41)774 S2 pP TX. '7'7$4s P.O. Box or Street City State Zip Order Address:$,4t-/E. Q( 121D .boD1 , Zip Remit Address: P.O. Box or Street City 412 131£3 4107:)f 1t State P.O. Box or Street City State Zip Federal Tax ID No.: ? Z — 222 4:A010 Date: 4) V 7' 2&� 2.01/1 END OF BID #07-111 CONFLICT 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. 1. Name of person doing business with local governmental entity. Azded-444-2 ecioriZaerro).7 ealiar4-10r 2. FORM CIQ OFFICE USE ONLY Date Received 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. CI Glenn Brown, City Manager O Robert Alley, Fire Chief O Pete Caler, Landfill Mgr. O David Gwin, Economic Dev. O David Massey, Electric O Bob Cowell, Planning & Dev O Cheryl Turney, Purchasing Mgr. O Terry Childers, Deputy City Mgr )4 Steve Beachy, Parks & Rec O Harvey Cargill, City Attorney O Connie Hooks, City Secretary O Becky Nugent, Public Relations O Mark Smith, Public Works O John Woody, W/WW O Kathy Merrill, Asst. City Mgr. O Ben Roper, Inf. Tech. O Michael Clancey, Police Chief O Jeff Kersten, Chief Fin.Officer O Julie O'Connell, Human Resources O Ed Spillane, Municipal Judge 0 NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: 7:44,-712 64,46 1(01 el -4(0261-20 67p- 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. O Ben White, Mayor 0 Ron Gay, Place 3 O David Ruesink, Place 6 City of College Station Elected Officials College Station City Council O OPEN, Place 1 0 Lynn Mcllhaney, Place 4 J ll NONE O James Massey, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions O Larry Ringer, Chairman O Mary Fran Troy • Sonio Margarita Gangotena O Sarah Adams, Chair O James Batenhorst O David Chester O Donald Braune O Dan B. Sears, Chairman O Mike Lane O Steve Parker, alternate O NONE B/CS Library Committee 0 Katherine Edwards 0 Jeanne Mitchell O James Bradford Cemetery Committee O Virginia Reese O Weldon Kruger O RC Slocum / NONE Construction Board of Adjustments and Appeals/Building & Standards Commission O Frank Cox Larry D. Patton O Glenn Thomas, alternate O Don Scherr O B. Carroll Johnson NONE O Kevin Myers O Joe Wallace O James Matson O David Hart O Charles Thomas, alternate O Quinn Williams Li Hillary Jessup, Chairman El Haskell Monroe El Ernie Wright )NONE Historic Preservation Committee O Bill Lancaster O Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee 0 Marguerite Anthony 0 Meredith Waller 0 Colleen Risinger O Tedi Ellison 0 J. Kevin Byrne 0 Deborah Deitering El Rusleen Maurice El Reba Ragdale 0 7 NONE O Jodi Warner, Chair 0 Shawn Rhodes O John Crompton NONE Parks and Recreation Board O Kathleen Ireland O Jody Ford O Harry Green Planning and Zoning Commission O John Nichols, Chair 0 Glenn Schroeder 0 Marsha Sanford 0 Dennis Christiansen El Harold Strong p NONE Li Rick Heaney O Alan King El Susie Cox, alternate El Jay Goss, Chair O Denise Whisenant NONE Design Review Board Li Hunter Goodwin Ward Wells O Robert Rayburn, alternate Zoning Board of Adjustments O Joshua Benn O Donald Braune 0 Joan Perry El Gary Thomas Li Gary Erwin 0 Derek Dictson 0 Bill Davis 0 Nancy Sawtelle O John Nichols 0 NONE O John Richards O Thomas Mather El Larry Hodges O Glenn Brown, City Manager 0 Sharon Colson, Chair O Kenny Mallard O Don Lewis O Gregg Baird O Chad Jones 0 Stephen Syptak, Chair O Tom Kirkland it NONE O Hugh Lindsay, Area I 0 John Crompton, Area II El Steve Arden, Area III 0 Hugh Steams, Area IV O Andrew Burleson, Student Resident El Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation O Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors El Larry Mariott WI NONE Wolf Pen Creek TIF Board O Marsha Sanford, Vice Chair 0 James Massey Outside Agency Funding Review 0 Charles Taylor 0 Sheryl Welford so NONE Northgate Tax Increment Finance Board O David Scarmardo 0 Glenn Thomas Comprehensive Plan Committee CI John Richards, Area I Ell Brian Bochner, Area II O Laurie Corbelli, Area III 0 Jerry Cooper, Area IV O Kristina Campbell, Alternate, Student Resident O Craig Hall, Resident -At -Large O Lynn Mcllhaney, Alternate, Councilmember O Gary Erwin, Parks & Rec O Larry Haskins, Northgate District Assoc. O Chris Scotti, Councilman O Marc Chaloupka NONE O Roger Reese O Carolyn Berrow O Anne Jackson O Dale O'Reiley 0 David Hart, Alternate, Area I O Dennis Corrington, Alternate, Area II O Tom Taylor, Alternate, Area III El Adrian Williams, Alternate, Area IV O Douglas Rape', ETJ Resident DI Mike Guido, Alternate, Resident -At -Large O Bill Davis, P&Z O Kathleen Ireland, Parks & Rec Alternate 0 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 El 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 ❑ Chad Bohne, Intergovernmental Comm/TxDOT O Michael Parks, Intergovernmental Comm/BVCOG ❑ Gary Arnold, Intergovernmental Comm/Brazos County Sheriff ❑ Gary Teston, Intergovernmental Comm/ Easterwood Airport ;SO 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. 0 Lynn Mcllhaney 0 Mayor O Mayor O Lynn Mcllhaney O Mayor O Ron Silvia / NONE O Ron Gay y NONE Brazos County Health Department 0 Ben White P1 NONE Brazos Valley Council of Governments NONE B/CS Metropolitan Planning Organization 7NONE BVCOG TMPA Regional Park Project Advisory Board NONE BVSWMA Policy Advisory Board O Chris Scotti City Center Committee O Ben White Intergovernmental Committee O Ben White NONE 0 Dave Ruesink 0 John Happ LJ Dave Ruesink NONE Joint City/School Intergovernmental Committee 0 Ben White 0 John Happ Sister Cities Association O Dave Ruesink )0 NONE Transportation Committee O Ron Gay 0 John Happ 0 Lynn Mcllhaney 0 Ken Fogle 0 Linda LaSuit, MPO 0 Dennis Christianson, TTI 111 Michael Parker, BVCOG 0 Bryan Woods, TxDOT , NONE O Ron Gay O John Nichols O Joan Perry Wolf Pen Creek Oversight Committee O Chris Scotti O Marsha Sanford O Sharon Colson 0 Marc Chaloupka 0 Jodi Warner X NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: potcr72.0 ,50177/4477272— A217-- P,grrr gi ezienzit.„ L__ p. 144P4) &&U.1, Alleven.V2r42. NAIL1To4k-Cr 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. e of person doing business with the governmental entity )r),J 4,12.,1 LTD. 404 24Pel Date Adopted 01/13/06 CONFLICT 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. 2. e401.)57124..) G.BYIP. y4 L77 - 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. ❑ Terry Childers, Deputy City Mgr Steve Beachy, Parks & Rec ❑ 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 ❑ NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: T. � - 4 QI '� y u SM. kr- , 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 1 ❑ Lynn Mcllhaney, Place 4 Af NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Mary Fran Troy ❑ Sonio Margarita Gangotena ❑ 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 ❑ Don Scherr ❑ Jeanne Mitchell ❑ B. Carroll Johnson ❑ James Bradford NONE Cemetery Committee ❑ Virginia Reese ❑ Weldon Kruger ❑ RC Slocum i0 NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Frank Cox Larry D. Patton ❑ Glenn Thomas, alternate ❑ Kevin Myers ❑ Joe Wallace ❑ James Matson ❑ David Hart ❑ Charles Thomas, alternate ❑ Quinn Williams ❑ Hillary Jessup, Chairman ❑ Haskell Monroe ❑ Ernie Wright NONE Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey ❑ Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ Marguerite Anthony ❑ Meredith Waller ❑ Colleen Risinger ❑ Tedi Ellison ❑ J. Kevin Byrne ❑ Deborah Deitering ❑ Rusleen Maurice ❑ Reba Ragdale ❑ hjA NONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton NONE ❑ John Nichols, Chair ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heaney ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Denise Whisenant O NONE Parks and Recreation Board ❑ Kathleen Ireland ❑ Jody Ford ❑ Harry Green Planning and Zoning Commission ❑ Glenn Schroeder ❑ Dennis Christiansen NONE Design Review Board ❑ Hunter Goodwin 11 Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin ❑ Derek Dictson ❑ Bill Davis ❑ Nancy Sawtelle ❑ John Nichols ❑ NONE ❑ John Richards ❑ Thomas Mather ❑ Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird El Chad Jones El Stephen Syptak, Chair ❑ Tom Kirkland ❑ NONE ❑ Hugh Lindsay, Area I ❑ John Crompton, Area II ❑ Steve Arden, Area III ❑ Hugh Stearns, Area IV ❑ Andrew Burleson, Student Resident ❑ Dorthea Robinson, Alternate, ETJ Resident ❑ Chris Scotti, Councilmember ❑ Hillary Jessup, Historic Preservation ❑ Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors ❑ Larry Mariott ❑ NONE Wolf Pen Creek TIF Board E l 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 El Brian Bochner, Area II ❑ Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ 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 ❑ Anne Jackson ❑ Dale O'Reiley ❑ 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 ❑ Linda LaSut, Intergovernmental Comm/MPO ❑ Lindsey Guindi, Intergovernmental Comm/Chamber of Commerce ❑ James Massey, Intergovernmental ❑ Comm/TAMU Admin ❑ Dr. Clark Ealy, Intergovernmental ❑ Comm/CSISD ❑ Chuck Martinez, ❑ Intergovernmental Comm/ Research Valley Patnership Rodney Weis, Intergovernmental Comm/TAMU Transit Dr. Colleen Netterville, Intergovernmental Comm/BISD Margie Lucas, Intergovernmental Comm/ Brazos Transit District ❑ Chad Bohne, Intergovernmental Comm/TxDOT ❑ Michael Parks, Intergovernmental Comm/BVCOG Gary Arnold, Intergovernmental Comm/Brazos County Sheriff Gary Teston, Intergovernmental Comm/ Easterwood Airport 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 i NONE Brazos Valley Council of Governments ❑ Ron Silvia, Mayor 0 NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor 0 NONE BVCOG TMPA Regional Park Project Advisory Board ❑ Lynn Mcllhaney ,0 NONE BVSWMA Policy Advisory Board ❑ Ron Silvia, Mayor ❑ Chris Scotti NONE City Center Committee ❑ Ron Silvia ❑ Ben White ❑ Dave Ruesink O NONE Intergovernmental Committee ❑ Ron Gay ❑ Ben White ❑ John Happ • NONE ❑ Dave Ruesink NONE Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Dave Ruesink #0 NONE ❑ Ron Gay ❑ Ken Fogle ❑ Michael Parker, BVCOG ❑ Ron Gay ❑ John Nichols ❑ Joan Perry Transportation Committee ❑ John Happ ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee ❑ Chris Scotti ❑ Marsha Sanford ❑ Sharon Colson ❑ Lynn Mcllhaney ❑ Dennis Christianson, TTI NONE ❑ Marc Chaloupka ❑ Jodi Warner ,d NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: bi,�';G r L.P. .501bpl t)/ S l ate. 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. -y) . Q_mmma•• person doing business with the governmental entity AQA)S vG t?,1.,] Lf?'t___ JO I- !n1 24212 Date Adopted 01/13/06 CONFLICT 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. Aion Ikk 1 a hi 4.14L, "frk4J,_._ 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 Jl 1 Steve Beachy, Parks & Rec ❑ Glenn Brown, City Manager ❑ Olivia Burnside, Inf. Tech. ❑ Pete Caler, Landfill Mgr. ❑ Harvey Cargill, City Attorney 0 David Massey, Electric ❑ Michael Clancey, Police Chief ❑ Lance Simms, Planning & Dev ❑ John Woody, W/WW ❑ Charles Wood, Economic Dev ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Finance ❑ Charles McLemore, Public Works ❑ Charles McLemore, Public Works ❑ Becky Nugent, Public Relations ❑ Julie O'Connell, Human Resources ❑ Mark Smith, Special Projects ❑ Ed Spillane, Municipal Judge ❑ Cheryl Turney, Purchasing Mgr. ❑ NONE Describe each affiliation or business relationship with an employee checked in Question 3 above: 6-4tvc 13eac,k.j - %rnu L' &Ass 7 I 4 9 classnc1/ 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 1 ❑ Lynn Mcllhaney, Place 4 A NONE ❑ John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Eric Miller ❑ Lois Koontz ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester ❑ Dan B. Sears, Chairman ❑ Mike Lane ❑ Steve Parker, alternate ❑ Karen Kasper, Merchant ❑ Joey Dunn, Dir. Planning & Dev X NONE B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Mary Lind Bryan 4 NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ George McLean, Vice Chair IX Larry D. Patton ❑ David Ruesink, alternate Facade Improvement Program Advisory Committee El Don Scherr ❑ Jo Berg X] NONE ❑ Kevin Myers ❑ Joe Wallace ❑ Frank Cox ❑ David Hart, alternate ❑ NONE ❑ Valerian Miranda, Architect ❑ Rick Lemmons, Business Owner ❑ Robert Mosley, City Engineer ❑ Eric Barton, CD Coordinator ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice Vil NONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton 0 NONE ❑ Scott Shafer, Chairman ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright Pci NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ John Nichols ❑ Dennis Christiansen 01 NONE Design Review Board ❑ Hunter Goodwin [ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Derek Dictson ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood ❑ Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer ❑ NONE ❑ John Richards ❑ Charles Taylor 12( NONE Research Valley Partnership Board of Directors ❑ David Hickson ❑ Larry Mariott ❑ Glenn Brown, City Manager X NONE ❑ Sharon Colson, Chair ❑ Kenny Mallard Wolf Pen Creek TIF Board ❑ Marsha Sanford, Vice Chair ❑ James Massey ❑ Chris Scotti, Councilman ❑ Marc Chaloupka Pe 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 ❑ Nancy Berry ki NONE Brazos Valley Council of Governments Board of Directors ❑ Ron Silvia, Mayors NONE B/CS Metropolitan Planning Organization ❑ Ron Silvia, Mayor I NONE BVCOG TMPA Regional Park Project Advisory Board ❑ Susan Lancaster 111 NONE BVSWMA Policy Advisory Board ❑ Ron Silvia, Mayor 0 Susan Lancaster g NONE ❑ Ron Silvia [A NONE ❑ Nancy Berry 1;4 NONE ❑ Nancy Berry CI NONE City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee ❑ Ben White ❑ John Happ Joint City/School Intergovernmental Committee ❑ Ben White ❑ John Happ Sister Cities Association ❑ Ron Gay ] NONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI fly NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Wolf Pen Creek Oversight Committee ❑ Ron Gay ❑ Chris Scotti k NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: Ward Gvclls - ne,jhhoc rry /94/10 - C'J 7/ n.,, 44,, l rRpt c Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ 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. erson doing business with the governmental entity July 3. 024o6 Date Adopted 01/13/06 CONFLICT 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. 1. Name of person doing business with local governmental entity. 2. C )a t eich-dr_it f j o n FORM CIQ OFFICE USE ONLY Date Received 1 Lfd. 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 el- Steve Beachy, Parks & Rec ❑ Glenn Brown, City Manager ❑ Olivia Burnside, Inf. Tech. ❑ Pete Cater, Landfill Mgr. ❑ Harvey Cargill, City Attorney ❑ John Woody, Utilities ❑ Michael Clancey, Police Chief ❑ Joey Dunn, Planning & Dev ❑ Don Fazzino, Legislative Liason ❑ Kim Foutz, Economic Dev ❑ Connie Hooks, City Secretary ❑ Jeff Kersten, Finance ❑ NONE ❑ 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: Tht u - Cless '( 14' c lass hidk .Toh /ick./Q h, 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 ❑ Susan Lancaster, Place 4 fc,i) NONE O John Happ, Place 2 ❑ Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman ❑ Eric Miller ❑ Lois Koontz ❑ Sarah Adams, Chair ❑ James Batenhorst ❑ David Chester O Dan B. Sears, Chairman O Mike Lane ❑ Steve Parker, alternate O Karen Kasper, Merchant O Joey Dunn, Dir. Planning & Dev 4NONE B/CS Library Committee O Katherine Edwards O Jeanne Mitchell O James Bradford Cemetery Committee ❑ Virginia Reese O Mary Lind Bryan NONE Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ George McLean, Vice Chair 0 Larry D. Patton ❑ David Ruesink, alternate Facade Improvement Program Advisory Committee O Don Scherr O Jo Berg VI NONE O Kevin Myers O Joe Wallace O Frank Cox O David Hart, alternate O NONE ❑ Valerian Miranda, Architect ❑ Rick Lemmons, Business Owner ❑ Robert Mosley, City Engineer 0 Eric Barton, CD Coordinator ❑ Hillary Jessup, Chairman ❑ Marguerite Anthony ❑ Thomas Taylor ❑ Colleen Risinger ❑ Rebecca Eplen ❑ Rusleen Maurice NONE ❑ Kathleen Ireland ❑ Carol Blaschke ❑ John Crompton 1ST( NONE Historic Preservation Committee ❑ Bill Lancaster ❑ David Ruesink ❑ Ernie Wright NONE Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulee Parks and Recreation Board ❑ Glenn Schroeder ❑ Jeannie McCandless ❑ Harry Green Planning and Zoning Commission ❑ Scott Shafer, Chairman ❑ John Nichols ❑ Marsha Sanford ❑ Dennis Christiansen ❑ Harold Strong L NONE ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Graham Sheffy ❑ Denise Whisenant Design Review Board ❑ Hunter Goodwin V Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune O Derek Dictson ❑ Marsha Crenwelge ❑ Dipankar Sen ❑ Neal Nutall, Jr. ❑ Mary Sherwood ❑ Peggy Samson ❑ Jodi Warner ❑ Gary Thomas ❑ Gary Erwin ❑ Ken Reynolds ❑ Bill Davis ❑ Nancy Sawtelle ❑ Scott Shafer ❑ NONE ❑ John Richards ❑ Charles Taylor A NONE ❑ David Hickson ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard Research Valley Partnership Board of Directors ❑ Larry Mariott NONE Wolf Pen Creek TIF Board ❑ Marsha Sanford, Vice Chair ❑ James Massey ❑ Chris Scotti, Councilman ❑ Marc Chaloupka rg 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. ❑ Susan Lancaster ❑ Ron Silvia, Mayor ❑ Ron Silvia, Mayor ❑ Susan Lancaster ❑ Ron Silvia, Mayor Brazos County Health Department ❑ Nancy Berry NONE Brazos Valley Council of Governments Board of Directors CY NONE B/CS Metropolitan Planning Organization Ey NONE BVCOG TMPA Regional Park Project Advisory Board C ' NONE BVSWMA Policy Advisory Board ❑ Susan Lancaster M NONE ❑ Ron Silvia 114. NONE ❑ Nancy Berry ly NONE ❑ Nancy Berry 1% NONE City Center Committee ❑ Ben White ❑ Nancy Berry Intergovernmental Committee ❑ Ben White ❑ John Happ Joint City/School Intergovernmental Committee ❑ Ben White Li John Happ Sister Cities Association ❑ Ron Gay CX NONE ❑ Ron Gay ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Transportation Committee ❑ John Happ ❑ Dennis Christianson, TTI NONE ❑ Ken Fogle ❑ Michael Parker, BVCOG Adopted 01/13/06 Wolf Pen Creek Oversight Committee ❑ Ron Gay ❑ Chris Scotti f ! NONE Describe each affiliation or business relationship with an employee checked in Question 4 above: La rr.1 e+46 - eSTti met 4 ( -roc gr; 711- Rice 1.:.:7e cif e , �•,- Ward litAi IL - helhhbor 1 n tVan-it,cke/. Skildil/isia n Adopted 01/13/06 CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity FORM CIQ 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. Qc6,.,, f;-19• 02% U U (o rson doing business with the governmental entity Date �Q n1 eot si"rli cf f o,) 4). , . Adopted 01/13/06