02-11-19 Regular Meeting of the La Porte City Council

Browse Search

CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor doing business with local governmental entity LY This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ON This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who Date eceived has a business relationship as defined by Section 176.001 (1 -a) with a local governmental entity and the vendor 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 vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code. A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor. Name of vendor w10 has a business relationship with local �governmental entity. 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 on which you became aware that the originally filed questionnaire was incomplete or inaccurate.) ation is being disclosed. hip with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIO as necessary. A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor? F—1 Yes | ~/ 0o B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction ,dthe local government officer nrafamily member ufthe officer AND the taxable income isnot received from the local governmental entity? E� 111 Yes if &L-ekAvi, 0� Hours an ownership interest of one percent or more. Checkthis box if the vendor has given the local government officer orefamUymember of the officerunemmore gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1). Signature of vendor doing busine—.9�-,th �the g �ernme`ntalentity� Date Form provided by Texas Ethics Commission w��.state.tx.vo Revisedn/30/2010