Garza, Irasema CIQ 5.9.23CONFLICT OF INTEREST QUESTIONNAIRE -FORM CIQ
For vendor or other business with local overnmental entit
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 176.000(a).
By law th is questionnaire must be filed with the records administrator of the loca l 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 176.000(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.
2
Name of vendor who has a business relationship with looal governmental entity. I'< AS 8, A--
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 !\'ame of local gon•rnment officer about whom th(' information in
Describe each employment or other business relationship with th local goYcmmcnt officer. or a family member of the officer. as described by St!ction
I 76.003(a)(2}(A). Also describe any family relation~ hip \\ith the local gm·emment officL'r. I hi-. -.ec1ion. (item 3 including subparu. /\. B. C & D). must be
completed for each officer \\ith whom 1hc ,·endor has an employment or other busines" reh1tion~hip a.., dcfint.:d by Section 176.00 I( I-a). Local Government Code.:.
Attach additional pages to this Fonn CIQ as nccc:ssary.
A. Is the local gmcrnment officer named in this section rccci,·i1rn or likch to rccci, L' taxahlc im:ome. Llther than inn:stmcnt income. from the Yendor? D Yes -.
13. Is the, endor rccci,·ine or likely to n:ccin: taxable inc.:omc. other than im C'>tmcnt im:01111..:. from or al the direction of the local gm cnunent officer named in
this section AND the ~axablc i,;comc is 1101 recci,·cd from thL· local g.ove111mc111al t.:ntit: .,
D ves
C. ls the filer of this questionnairc employed by a corporation or other bu:,ines, cnti1: n ith re..,pcct to which the local gm cnuncnt officer scne:, a:, an olfo.:LT
or director. or hold:, an 0\\11crship or one percent or 11H11\:·.1
D Ye:,
D. Dc:,cribe each cmploymelll or bu:,inc,i:, and family relationship with tht: local gm·cmmcnl llrticcr named in thb ~cction.
I have no Conflict of Interest to disclose.