Axis Construction LP CIQ 8.21.23CONFLICT OF INTEREST QUESTIONNAIRE -FORM CIQ
For vendor or other erson doln business with local ovemmental enf
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) and by City of Denton
Ethics Code, Ordinance 18-757.
By law this questionnaire must be filed with the records administrator of the local government entity not later than the 7th business day after th
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. D
(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 loeal 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 of1he officer, as descnDed by Section
I 76.003(a)(2)(A). Also desco1>e 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 176.00 1(I-a), Local Government Code.
Attach additional pages to this FOl1ll 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? o Yes DNo
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction ofthe local government officer named in
this section AND the taxable income is not received from the local governmental. entity?
o Yes DNo
C. Is the mer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer selVes as an officer
or director, or holds an ownership of one percent or more?
D Yes DNo
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.
s
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor doing business with local governmental entity
Acomptete copy ofChap1er 176 ofthe Local Government Code may befound at http://www.statutes.1egis.state.tx.uslDocsILG/btm/LGJ76.htm. For easy
reference, below are some ofthe sections cited on this fonn.
LoeaI Government Code § 176.801(1...): "Business relationsbip" means a connection between two or more parties based on commercial activity ofone ofthe
parties. The term does not include a connection based on:
(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity oran agency ofa federal, state, or local
governmental entity;
(B) a transaction conducted at a price and subject to tenns available to the pUblic; or
(C) a purchase or lease ofgoods orservices from a personthat is chartered by a state or federal agency and that is subject to regular examination by.
and reporting to, that agency.
Log. Goyernment Code § 176.oo3(a)(2)(A) and (8):
(A) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(2) the vendor:
(A) bas an employment or other business relationship with the local government officer ora family member ofthe officer that
results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during
the 12-month period preceding the date that the officer becomes aware that
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the verdJr;
(8) bas given tothe local government officer or a family memberofthe officer one or more gifts thathave an aggregatevalueofmore
thanSl00 in the 12-monthperiodpreceding the date the officer becomes aware that
(i) a contract between the local governmental entity and vendor bas been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
Local Government Code § 176.006(8) and (a-1)
(a) A vendor shall file a completed conflict ofinterestquestionnaire iftbe vendor bas a business relationship with a local governmental entity and:
(I) has an employment or other business relationship with a local government officer ofthat local governmental entity, ora family member
oftbe officer, described by Section 176.003(a)(2)(A);
(2) has given a local government officer ofthat local governmental entity, or a family member of the officer, one or more gifts with the
aggregate value specified by Section 176.003(aX2)(B), excluding any giftdescribed by Section 176.003(a-l); or
(3) has a family relationship with a local government officer ofthat local governmental entity.
(a-I) The completed conflict ofinterest questionnaire must be filed with the appropriate records administrator not latertban the seventh business day
afterthe later of:
( I) the date that the vendor:
(A) begins discussions or negotiations to enter into a contract with the local governmental entity; or
(8) submitsto the local governmental entity an application, Tesponse to a:requestforproposals OT bids, correspondence, or another
writing related to a potential contract with the local governmental entity; or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship with a local government officer, or a fiunily member ofthe officer,
described by Subsection (a);
(8) that the vendor bas given one or more gifts described by Subsection (a); or
(C) ofa family relationship with a local government officer.
City of Denton Ethics Code Ordinance Number 18-757
Definitions:
Relative: a family member related to a City Official within the third 3rd degree ofaffinity (marriage) or consanguinity (plood or ado.ption)
City Official: for purpose of this article, the tenn consists ofthe Council Members, Department Heads, or member ofthe Board ofEthics, Planning
and zoning Commission Members, Board ofAdjustment, Historic Landmark Commission, or Public Utilities Board
Vendor: a person who provides or seeks to provide goods, services, and/or real property to the City in exchange fur compensation. This definition
does not include those property owners from whom the City acquires publicright-of.way or other real property interests for public use.
Per the City ofDenton Ethics Code, Section 2-273. -Prohibitions
(3) It shall be a violation ofthis Article for a Vendor to offer OT give a Gift to City Official exceeding fifty dollars ($50.00) per gift, or multiple gi
cumulatively valued at more than two hundred dollars ($200.00) per a single fiscal year.
Per the City ofDenton Ethics Code, Section 2-282. -Disposition (b), (5) Ineligibility
Ifthe Board of Etbics finds that a Vendor has violated this Article, the Board may recommend to the City Manager that the Vendor be deemed
ineligible to enter into til City cootract or other arrangement for goods, services, or real property, fOT a period ofone (l) yeaT.
orm provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/3012015