Green Planet, IncCONFLICT OF INTER ST QUESTIONNAIRE FORM CIQ
For vendor or other n doinq business with local overnmental en
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who 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).
BV law this questionnaire must be filed with the records administrator of the local government 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 'l 76.006, Local Government Code. An offense under this section is a
misdemeanor.
Ll Gheck this box if you arle 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.)
Name of local gove rnment officer about whom the information in this section is being disclosed.
N/A
I have no Conflict of lnterest to disclose.
the governmental entity
Name of vendor who has a business relationship with local governmental entity.
Green Planet, Inc.
l)esoribe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section
l7(r.003(a)(2)(A). Also describe any fainily relations hip with the local government officer. This section, (item 3 including subparts A. B, C & D). n'rust be
conlpleteci1br.eachoffcerwitlrwhorrri1revendorhasanemploymentorotherbusiness
,{ttacli additional pages to this Form CIQ as necessary.
A. ls lhe local govemmeut oflicer named in this section receiving or likely to receive taxable income, other than investment iucome. fiom the vendor?
L lYe.. I lNo
lstltevendorreceivingorlikelytoreceivetaxableittcome,otherthalrinvestmentincotne,
this section AN D the taxable income is not received frorn the local govemmental entity?
l -l "., l--l *o
ls the iller ofthis questionnaire employed by a corpolation or other business entity with respect to which the local govemment officet'serves as an olTlcer
or director'. or holds an oivnership ofone perceut or more?
LI".,I*o
Desoibe each employment or business and family relationship with the local govemment officer named in this section.
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
Acomplete copy of Chapter 176 ol the Local Governmenl Code may be found at http://wwwstatutes.legis.state.tx.usi
Docs/LG/htm/LG.1 76.htm. For easy reference, below are some of the sections cited on this form.
Local Government Code $ 176.001(1-a): "Business relationship" means a connection between two or more parties
based on commercial activity of one of the parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an
agency o{ a federal, state, or local governmental entity;
(B) a transaction conducted at a price and subject to terms available to the public; or
(C) a purchase or lease of goods or services f rom a person that is chartered by a state or Jederal agency and
that is subject to regular examination by, and reporting to, that agency.
Local Government Code S 176.003(aX2XA) and (B):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if :
(2) the vendor:
(A) has an employment or other business relationship with the local government oificer or a
family member of the officer that results in the officer or family member receiving taxable
income, other than investment income, that exceeds $2,500 during the .12-month period
preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed;
or
(ii) the local governmental entity is considering entering into a contract with the
venoor;
(B) has given to the local government officer or a family member of the officer one or more gifts
that have an aggregate value of more ihan $1 00 in the 12-month period preceding the date the
officer becomes aware that:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contraet with the vendor.
Local Government Code $ 176.006(a) and (a-1)
(a) Avendor shallfile a completed conf lict of interest questionnaire if the vendor has a business relationship
with a localgovernmental entity and:
(1) has an employment or other business relationship with a local government officer of that local
governmental entity, or a family member o{ the officer, described by Section 176.003(aX2)(A);
(2) has given a local government officer of that local governmental entity, or a family member of the
officer, one or more gi{ts with the aggregate value specified by Section 176.003(aX2XB), excluding any
gift described by Section 176.003(a-1); or
(3) has a lamily relationship with a local government officer of that local governmental entity.
(a-1) The completed conflict of interest questionnaire must be filed with the approprrate records adminrstrator
not later than the seventh business day after the later of :
{1) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local governmental
entity; or
(B) submits to the local governmental entity an application, response to a request for proposals
or bids, correspondence, or another writing related to a potential contract with the local
governmental entity; or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer, or a
family member of the officer, described by Subsection (a);
(B) that the vendor has given one or more gifts described by Subsection (a); or
(C) of a family relationship with a local government officer.
Form provided bv Texas Ethics Commission www.ethics.state.tx.us Revised 1113012015