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HomeMy WebLinkAboutCopy CornerCONFLICT 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. d4 ,,ev 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 O Steve Beachy, Parks & Rec ❑ Harvey Cargill, City Attorney ❑ Connie Hooks, City Secretary ❑ Becky Nugent, Public Relations ❑ Mark Smith, Public Works ❑ John Woody, W/WW O Kathy Merrill, Asst. City Mgr. ❑ Olivia Burnside, Inf. Tech. ❑ Michael Clancey, Police Chief ❑ Jeff Kersten, Chief Fin. Officer ❑ Julie O'Connell, Human Resources O Ed Spillane, Municipal Judge etfrICIONE 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 1 O Lynn Mcllhaney, Place 4 ��NONE� ❑ John Happ, Place 2 O Chris Scotti, Place 5 City of College Station Committees, Boards, and Commissions ❑ Larry Ringer, Chairman O Mary Fran Troy ❑ Jennifer Bohac ❑ Sarah Adams, Chair ❑ James Batenhorst El David Chester O Donald Braune ❑ Dan B. Sears, Chairman O Mike Lane ❑ Steve Parker, alternate J2'1GONE B/CS Library Committee ❑ Katherine Edwards ❑ Jeanne Mitchell ❑ James Bradford Cemetery Committee ❑ Virginia Reese ❑ Weldon Kruger ❑ RC Slocum Construction Board of Adjustments and Appeals/Building & Standards Commission ❑ Frank Cox ❑ Larry D. Patton ❑ Glenn Thomas, alternate ❑ Don Scherr ❑ B. Carroll Johnson 21CroNE ❑ Kevin Myers ❑ Joe Wallace ❑ James Matson ❑ David Hart ❑ Charles Thomas, alternate ❑ Quinn Williams ❑ Hillary Jessup, Chairman 0 Haskell Monroe ❑ Ernie Wright (—NONE' ❑ Rebecca Eplen ❑ Rusleen Maurice ,-NONE ❑ Jodi Warner, Chair ❑ Shawn Rhodes ❑ John Crompton NONE14 ❑ John Nichols, Chair ❑ Marsha Sanford ❑ Harold Strong ❑ Rick Heany ❑ Alan King ❑ Susie Cox, alternate ❑ Jay Goss, Chair ❑ Denise `W/hi senant -NONE 7�" Historic Preservation Committee ❑ Bill Lancaster ❑ Jane Hughey O Neal Nutall, Jr. Joint Relief Funding Review Committee ❑ J. Kevin Byrne ❑ Charlotte Mikulee Parks and Recreation Board O Kathleen Ireland ❑ Jody Ford ❑ Harry Green Planning and Zoning Commission ❑ Glenn Schroeder ❑ Dennis Christiansen ErNONE1 Design Review Board O Hunter Goodwin ❑ Ward Wells ❑ Robert Rayburn, alternate Zoning Board of Adjustments ❑ Joshua Benn ❑ Donald Braune ❑ Marguerite Anthony ❑ Meredith Waller O Colleen Risinger ❑ Deborah Deitering ❑ Peggy Samson ❑ Joan Perry ❑ Gary Thomas ❑ Gary Erwin ❑ Derek Dictson ❑ Bill Davis ❑ Nancy Sawtelle ❑ John Nichols -ONE .44 ❑ John Richards ❑ Thomas Mather .lam Larry Hodges ❑ Glenn Brown, City Manager ❑ Sharon Colson, Chair ❑ Kenny Mallard ❑ Don Lewis ❑ Gregg Baird ❑ Chad Jones ❑ Stephen Syptak, Chair ❑ Tom Kirkland NONE ❑ Hugh Lindsay, Area I ❑ John Crompton, Area II ❑ Steve Arden, Area III O Hugh Stearns, Area IV ❑ Andrew Burleson, Student Resident ❑ Dorthea Robinson, Alternate, ETJ Resident O Chris Scotti, Councilmember O Hillary Jessup, Historic Preservation ❑ Lloyd Wasserman, County Commission Research Valley Partnership Board of Directors ❑ Larry Mariott -13-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 O David Scarmardo ❑ Glenn Thomas Comprehensive Plan Committee ❑ John Richards, Area I ❑ Brian Bochner, Area II ❑ Laurie Corbelli, Area III ❑ Jerry Cooper, Area IV ❑ Kristina Campbell, Alternate, Student Resident O Craig Hall, Resident -At -Large ❑ Lynn Mcllhaney, Alternate, Councilmember ❑ Gary Erwin, Parks & Rec ❑ Larry Haskins, Northgate District Assoc. ❑ Chris Scotti, Councilman ❑ Marc Chaloupka ,O -NONE ❑ Roger Reese O 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 El 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 CommBISD ❑ 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 0 Ben White C-KiONE Brazos Valley Council of Governments O Ron Silvia, Mayor 42'ONE51.- B/CS Metropolitan Planning Organization 0 Ron Silvia, Mayor 'NONE ® BVCOG TMPA Regional Park Project Advisory Board O Lynn Mcllhaney NONE9 BVSWMA Policy Advisory Board O Ron Silvia, Mayor ❑ Chris Scotti L ONE ❑ Ron Silvia I2--NONE4" O Ron Gay C ONI City Center Committee ❑ Ben White 0 Dave Ruesink Intergovernmental Committee 0 Ben White 0 John Happ ❑ Dave Ruesink T NONE Joint City/School Intergovernmental Committee ❑ Ben White Sister Cities Association ❑ Dave Ruesink INONE- ❑ Ron Gay ❑ Ken Fogle ❑ Michael Parker, BVCOG ❑ Ron Gay Transportation Committee ❑ John Happ ❑ Linda LaSuit, MPO ❑ Bryan Woods, TxDOT Wolf Pen Creek Oversight Committee O Chris Scotti ❑ John Happ ❑ Lynn Mcllhaney O Dennis Christianson, TTI E1 -NONE' [NONE Describe each affiliation or business relationship with an bay.R J /keys. ?rCS.t ie&,, e d t <, -mi., 04 employee checked'in Question 4 above: Cav K; 1.4 sever L/I6uc7(1-trr 1 -P re,(,eg S R -c - 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 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 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 D. Describe each affiliation or business relationship. 6. .��GrG zoP7 Signature of person doing busi -ss with the :.vermnental entity Date Adopted 01/13/06