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HomeMy WebLinkAboutHDR, IncCity of College Station CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session. This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a person who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the person meets requirements under Section 176.006(a). By law this questionnaire must be filed with the records administrator of the local governmental entity 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 knowingly violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor. OFFICE USE ONLY Date Received F�� J f 20,? si �, 4 .i tt, k...4....., J Name of person who has a business relationship with local governmental entity. HDR Engineering, Inc. ?J ❑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 the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.) 3 Name of local government officer with whom filer has employment or business relationship. No known employment or business relationships. with whom the filer has an Code. Attach additional other than investment income, from or at the not received from the local respect to which the local in this section. Name of Officer This section (item 3 including subparts A, B, C & D) must be completed for each officer employment or other business relationship as defined by Section 176.001(1-a), Local Government pages to this Form CIQ as necessary. A. Is the local government officer named in this section receiving or likely to receive taxable income, income, from the filer of the questionnaire? Yes No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment direction of the local government officer named in this section AND the taxable income is governmental entity? Yes No C. Is the filer of this questionnaire employed by a corporation or other business entity with government officer serves as an officer or director, or holds an ownership of 10 percent or more? Yes No D. Describe each employment or business relationship with the local government officer named II i „..,, % , • Kell J. Kaatz PE 02/03/2012 Sig :cure g1yon doi g buy ess with the governmental entity Date Adopted 06/29/2007 City of College Station Filer's Name Date Filed Affiliations Question 5 Reference Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the Part B local government officer named in this section AND the taxable income is not from the local governmental entity? 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? Part A Page 1 of 1 Espanol I Other 111 HDR, Inc. HDR, Inc. 6/8/2007 Part C Affiliation Part A Part B Part C Description Describe each affiliation or business relationship with an employee checked in Question 3 Describe each affiliation or business relationship with an employee checked in Question 4 Describe any other affiliation or business relationship that might cause a conflict of interest Return To Search Page Home I Government I Business I Resident I Visitors I Services I Online I Links PO Box 9960 College Station, TX 77842 I Contact Us I Site Map © 2008 City of College Station. All Rights Reserved. Policies http://10.1.0.150/ciq/view/viewdetails.asp?id=522 7/21/2010