Techline, Inc. CIQ 2021CONFL][CT OF INTEREST QUEST[ONNA][RE o
For" vendor or oiher person doinj] business with Ioealgovernmental entit
This questionnaire reflects changes made to tile law by H.B. 23, 84th Leg., Regular Session.
FORN[ CIQ
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).
By law this questionnaire nmst be filed with the records administrator of the local goverumenl entity not later than the 7th business day after'
the date tire vendor becomes aware of Pacts thal require the statemenl 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 ander this section is a
lnisdenleanor.
l-lName of vendor who has a business relationship with local governmental entity.
2 L Check this box if you are filing an update to a previously filed questiommire,
(The law requires that you file an updated completed questiolmaire with the appropriate filing authority not later than the 7th business day after the
date on which you became aware that the orlglnall;¢ filed questionnaire was incomplete or inaccurate.}
3 Name of local government officer ahout whonl the information in this section is being disclosed.
Name of Officer
This section, (item 3 including subparts A, B, C & D), must be completed for each officer with whom the vendor has an employment or other business relationship
as defined by Section 176.001(I-a), Local Government Code. Attach additional pages to this Form CIQ as aecessaD,.
A. Is the local government officer named inaction receb,,ing or likely to receive taxable income, other than investment income, fi'om the vendor?
[Yes L.Y-No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, fiom or at the direction of the local government officer
named in this section AND the taxable income/as not received fi'om the local govermnental entity?
r77-'-7 Yes No
C,Is the filer of this questionnaire employed by a COl]3oration or other business entity with respect to which the local government officer serves as an
officer or director, or holds an ownership of one percent or more?
[Yes [/No
D,Describe each employlnent or business and family relationship with the local government officer named in this section.
I have no Conflict of Interest to disclose.
Signature of vendor doing business with the governmental entity k,Date "
Exhibit F
Conflict of Interest Questionnaire
DocuSign Envelope ID: 1FBCA377-DFF3-43AB-83D6-9D1979958FA3