Discount Sports Nutrition CIQ 8.18.22CONFLICT OF INTEREST QUESTIONNAIRE -
FORM CIQ
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For vendor or other arson doin business with local overnmental entit
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
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a local gorclanceovemmen al entity and the vendor meets requireth Chapter 176, Local Government ments under Section 176.006(a) and byylCity of Denton
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Ethics Code, Ordinance 16-757.
dateethe vlendorsbecomes aware of faects with
require h a statementtto be tfiled. See Sect on 176.006(o -V4, LocalGovernment Code,business than the 7th day after t
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is
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of vendor who has a business relationship with local governmental entity.
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❑Cheek this box If you are fliing 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 711 business day
after the date on which you became aware that the origlnally filed questionnaire was Incomplete or inaccurate.)
Name of local government officer about whom the information in this section Is being disclosed.
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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 relationship 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 localgoprament officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor?
Yes a No
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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 MNo
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?
((((1P yes M No
D. Describe each employment �or, (bu�siness and family relationship with the local government officer named in this section.
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❑ I have no Conflict of Interest to disclose.
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the governmental entity Date