Logiball CIQ 6.18.21L.L-Q\2021-06-18Signature of vendor doing business with the govemrnental entityDate4Describe each employrnent or other business relationship with the local govermnent officer, or a family mernber of the offìcer, as described by Section176.003(aX2)(A). Also describe any family relations hip with the local govemment officer. This section, (itern 3 including subparts A, B, C & D), must becompleted for each ofTicer with whom the vendor has an employment or other business relationship as defined by Section I 76.00 I ( I -a), Local Covemrnent Code.Attach additional pages to this Fonn CIQ as necessary.A. ls the local govemment officer named in this section receiving or likely to receive taxable incorne, other than investment income, from the vendol'?YesNols the vendor receiving or likely to receive taxable income, other than investment incorne, frorn or at the direction ofthe local govemment officer named inthis section AND the taxable incorne is not received from the local govemmental entity?YesNoCIs the filer of this questionnaire ernployed by a corporation or other business entity with respect to which the local govemlnent officer serves as an olficeror director, or holds an ownership of one percent or more?YesNoD. Describe each employment or business and lamily relationship with the local govemment officer narned in this section.Name of Iocal government officer about whom the information in this section is being disclosed.N/AName of OfficerTGheck this box if you are filing an update to a previously filed questionna¡re.(The law requires that you fìle an updated completed questionnaire with the appropr¡ate filing authoriÇ not later than the 7rh business dayafter the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)1This questionna¡re reflects changes made to the law by H.8.23, 84th Leg., Regular Sess¡on.This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as definedby 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 govemment ent¡ty not later than the 7th business day after thedate 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 am¡sdemeanor.CONFLICT OF ¡NTEREST QUESTIONNA¡RE .For vendor or other person doing business with local governmental entityFORM CIQtrI have no Conflict of lnterest to disclose.Name of vendor who has a business relat¡onsh¡p w¡th local governmental ent¡ty.iball lnc.