Oklahoma City University CIQ 1.14.22 CONFLICT OF INTEREST QUESTIONNAIRE -FORM CIQForvendororotherpersondoingbusinesswithlocalgovernmentalentity
This questionnaire reflects changes madeto the law by H.B.23,84th Leg.,Regular Session.
This questionnaire is beingfiled in accordance with Chapter 176,Local GovernmentCode,by a vendor whohasa businessrelationship as defined
by Section 176.001(1-a)with a local governmentalentity and the vendor meets requirements under Section 176.006(a).By law this questionnaire mustbefiled with the records administrator of the local governmententity notlater than the 7th business day after the|date the vendor becomes awareof facts that require the statementto befiled.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 amisdemeanor.
4 Name of vendor whohasa businessrelationship with local governmentalentity.
Odlahbma_Cry University
Checkthis boxif youarefiling an update to a previouslyfiled questionnaire.
(The law requires that youfile an updated completed questionnaire with the appropriatefiling authority not later than the 7"business day
after the date on which you becameawarethatthe originally filed questionnaire was incomplete orinaccurate.)
[3] Nameof local governmentofficer about whom the informationin this section is being disclosed.
NameofOfficer
Describe each employmentorother business relationship with the local governmentofficer,or a family memberoftheofficer,as described by Section
176.003(a)(2)(A).Also describe anyfamily relations hip with the local governmentofficer.This section,(item 3 including subparts A,B,C &D),must be
completed for each officer with whomthe vendor has an employmentorother businessrelationship as defined by Section 176.00 1(1-a),Local Government Code.Attach additional pagesto this Form CIQ as necessary.
A.Is the local governmentofficer namedin this section receiving orlikely to receive taxable income,other thaninvestmentincome,from the vendor?
LJ Yes No
B.Is the vendorreceivingorlikely to receive taxable income,other than investment income,from orat the direction of the local governmentofficer named inthissectionANDthetaxableincomeisnotreceivedfromthelocalgovernmentalentity?
LJ Yes [4 No
C.Is the filerofthis questionnaire employed by a corporationor other business entity with respect to whichthe local governmentofficer serves as an officerordirector,or holds an ownership ofone percent or more?
LJ Yes Fi
D Describe each employmentorbusiness and family relationship with the local governmentofficer namedinthis section.
a
|_|I have no Conflict of Interest to disclose.
|;Hy //—_.Rime LAL /\4 [2022-
Signature of vendor doing busines#with gofernmental entity Date