Zoho Corp CIQ 6.7.22CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
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).
By 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 176.006, Local Government Code. An offense under this section is a
misdemeanor.
1 Name of vendor who has a business relationship with local governmental entity.
2
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.)
3 Name of local government officer about whom the information in this section is being disclosed.
Name of Officer
Describe each employment or other business relationship 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 relations hip with the local government 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(1-a), Local Government Code.
Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in
this section AND the taxable income is not received from the local governmental entity?
Yes No
C. Is the filer of this questionnaire employed by a corporation 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 employment or business and family relationship with the local government officer named in this section.
4 I have no Conflict of Interest to disclose.
5
Signature of vendor doing business with the governmental entity Date
Zoho Sign Document ID: 0YNHTQFWPCHZNRYBG47G_KDUE5KDCDEFXWXT8M-ZGFW
Generated on Jun 7, 2022 08:57 IST
Document ID :0YNHTQFWPCHZNRYBG47G_KDUE5KDCDEFXWXT8M-ZGFW
Document Name :CONFLICT OF INTEREST QUESTIONNAIRE_cityofdenton 06 June 2022
Sent by :Ashwin S A <ashwin.annadurai@zohocorp.com>
Organization :Zoho Corporation
Sent on :Jun 6, 2022 17:00 IST Signers :1
Completed on :Jun 7, 2022 08:57 IST Receives a copy :3
Sign order :Sequential Approvers :0
No. of documents :1
Summary
Recipients
Certificate of Completion
Signer
Vijay Sundaram
vijay.sundaram@zohocorp.com
Emailed on :Jun 6, 2022 17:00 IST Accessed from :174.246.193.242
Viewed on :Jun 7, 2022 08:57 IST Device used :Mobile
Signed on :Jun 7, 2022 08:57 IST Authentication type :None
Signature
Viewer
Mary McFall
mary.mcfall@cityofdenton.com
Emailed on :Jun 7, 2022 08:57 IST Accessed from :-
Viewed on :-Device used :-
Authentication type :None
Viewer
Priya
priya@manageengine.com
Emailed on :Jun 7, 2022 08:57 IST Accessed from :-
Viewed on :-Device used :-
Authentication type :None
Viewer
Akilan Jv
akilan.jv@zohocorp.com
Emailed on :Jun 7, 2022 08:57 IST Accessed from :-
Viewed on :-Device used :-
Authentication type :None
Zoho Sign Document ID: 0YNHTQFWPCHZNRYBG47G_KDUE5KDCDEFXWXT8M-ZGFW