Jimenez Plumbing CIQ 6.8.23CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other pertion doing business with local goverrimental anti
This questionnaire reflects changes meds to the law by H.B. 23, BQh Leg., Regular Session.
This quer earmaire is being filed in accodanm w1M Chapter t76, Local Govemment Code, by a vendor who has a business rehtlonshty as donned
by Section 176.001(1-a) with a local governmental entity and dre vendor meets requirements under Sectlon 176.006(a) and by Cry of Denton
Ethem Cade, Ombartce 16-757.
By law this questionnaire most be filed with the retards administrator of Me local gm mment entity rest later Nan the 7th business day after N
date ton vendor becomes aware of facts that require Me statement to be filed. See Section 176.006(a-1), Local Govemmenl Code.
A vector commits an change d Me vendor AnovAngly Nolates Slacken 176.006, Local Govemme d Code. An Sol under MIS section is a
m%demeanor.
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Hatne ofvantlor who has a business relationship w legal gawrmmnetl Study.
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❑ ChacA MIS bwrHyeah am filing an uptlaet tea Previously filed questionnaire.
(The bw requites Mat you file an updalM completed questionnaire Sion Me aPPmpdeet Miss auytodty not hear Man for P btelneser day
after Me data an arch you become aware IMI fire originally Ned questionnaire was Incomplete or haccurah.)
3 1 NOW OflocY tavemmmt ofli Seem whom the leformedon to Mb urlbn Is being Mulmd.
Nmre of tMxer
Pxnbe ma employment or Mlle business relationship weds the local government omen, ora hmily nemb rof es ommr. Sodmenhard by 6aedon
176003(a)(2)(A). Almdc¢beeryf ily relsiambip with the local gowmnwnt officer. Thea¢tion,Clan)mclWmgnrlprte A.9.CB DI. muelM
complarl forma omeerwiM wham the vandor M1m an empbyment orogvburm¢s relationship ssdest ed by seeks 176,01 Taal Commencer Code.
Atlech additional Seem m this Form CIQ as nemsmry.
A. hthebW gawmmenraffmrnoma in' rtcnvbBorlikpiYbmxiwtanabla irrunw, dherthm inveammtincome, fiam M<vendaff
�M/ias1ection
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Ym No
B. Is the maker nceivurg or likely to receive moble homes. other Men inwrtmat bcarv%non ore the thresher of the local guvemment officer named IS
this section AND the moble income is oat remived from We tical govemmeoml mtiry4
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Yea No
C. Is Me filer of this questionnaire cloyed by a corporation or athtt bmioms entity with respect Is which the local government officer seroma eo officer
or agrees", or Mira an ownership of am Seremt or more?
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year No
D. Desmoneagh euprloYowolmbtdoss+andr lily relatioeship withthe but gvvwmentaffcvnamNinthbsecMn. `
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Air, is (Nvt%"g u3 '% Re.�w Sr�gsl'()1Qc- 111 w
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I have tq Conflict M Method et discharge.
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Sdmi ofmatter doingistnm with Me governmental wiry Dam