SPL Inc aka Southern Petroleum Laboratories Inc CIQ 11.29.22cor{FLrcr oF II\TEREST QUESTTONNATR.E
coI{FLrcT oF TNTEREST QUESTIOT{NAIRE -
For vendor or other person doing business with local governmental entity
FORM CIQ
This questionnaire reflects changes rnacle ta the law by Fi.B. 23, 84th Leg., Regular Sessio*.
I'his questionnaire is being filed in accorciance with Chapter 176, Local Coveniment Code, by a vr:ndor who has a business relationship as
defined by Section 176.00 l(l-a) with a local govemmental entity and the vendor meets requirements under Section 176.006(a).
tsy law this questionnaire must be filed with the recortls administrator olthe local government eriti'::i not iater thaq the 7th business ciay after
rhe date the vendor becomes aware of facts that require the statement to be filed. See Secticn 176.006(a-1). l.ocal Govemment Code.
A vendor commits an offense if the vendor knowingly violates Section 176.006. Locai Goverrrnterit Code. An offense underthis section is a
misdemeancr.
Name of vendor who has a business relationship with local governmental entity.I
2 L_-] ( heck this box if 1ou are filieg.t'l irlidale ro a preriousll filed questionnairc.
date on u'hich became anare ti:ar lhe or inaccurate\i!'asfiled
J Name of local government o{ficer about whom the in this section is being disclosed.
Name of Officer
relationshipasdeflnedbySeciionlT6.00l(l-a). l.o,:ai Coretr- i.r.rentf'ode. Attaohadditional pagestothisForltCiilasneccssary.
Yes No
named in this section AND the taxabie inoomc is not receivcd liom the local governmental entitr''l
Yes r\t)
C. ls the iiler of this qucstionnaire employed b1,a corporation or other business entit) with respeot to rvliich the iocal govemment officer serves as an
olllcer or dircctor. or holds an onnet'sirip ill' cilc percent or morel-
Yes
D. Describe cach emplol-ment or business rnd larnily reiationship *,ith the local govcrnnrent otllcer named in thrs scction.
I
l/-71 -70D
llic !1{-,\ ciii;tcntal er.liit1'i)ateiloing
M I have no Conflict oflnterest to disclose.#tu-tll