Loading...
HomeMy WebLinkAboutForm CIQ Furniture Expressions 06-06-2014CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity This questiciiinalre reflects chano" , made to the law by H.B. 1491, 86th I Leg., Regular session.' OFFICEUSEONLY. This questionnaire i&being fildd1h:accordande with, Chapter 176, Local Government Code 'Date Reddivid by dperson who, has a business relationship as defined by Section 176.00.11.(17a) with a local 'Is ... meets under Section 176.006(a). - governmental entity and the person,meL requiremen By law this questionnaire must be filed with the records:administrator of the local governmental entity not Wert . han the 7th business day after the date the person becomes aware of facts ,that require.,the statement to be filed. Seetect.lon 176.606, Local apyernment. Code. A person commits :an offense: if the person knowingly' violates Section 17 6.006, Local Government Code; An offense under this section is a,Class C misdemeanor. - 1 Name of person who has a business - relationship With local.goverrimenta.tentity. . Check this -box ff yowiretiling a6 update toarof9Vl6USIYfiled questionnaire. (The law requires that, you file an, updated. completed questionnaire, with the, appropriate 'filing authority not laterthan 'the 7th. bti§iheiss.day Met the date the''onginally fildd.questibmaire bedomeis incomplete or inaccurate,) Name of local goverrimprit officer with whom filer has e pi oyment or business relationship. • Name bf.:0fficd­r This.section (item­3 including subparts A, B, C & D1.) must be.completed for each offlPer with whom the filer has an employment or other .business -relationship: -iis.defindd: by. Section 176,001(1-e)j. Local Government Code. Attach additional ,pages to this form CIO- as necessary.. .A, 'Is the focal govemihent:officer named in this. section receiving or likely torecelve taxable income, other than.investment income, from the filer of the questionnaire? El Yes No B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the dir6dtioni oft he local government offic& named in this siaction-AND'the taxable income is not received from the local :governmental : entity? Yes No C. Is the filer of.this questionnaire employed by azdtpdration or other business entity with respect to which the local government officer serves as an officer or'director, or.hold,s an ownership of 10parcent ormore? Yes F-1. No :D, Describe each employment or business relationship with the local government offider named :in this section. grU _ign of person doing business-4 the-govemmefflal entity Date Sai �r Adopted 05120i2007