Cunningham Recreation CIQ 1.9.24CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY
This questionnaire is being filed In accordance with Chapter 176, Local Government Code, Date Received 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).
By law this questionnaire must be filed with the records administrator of the local governmental 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 176.006(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.
!TI Name of vendor who has a business relationship with local governmental entity.
Cunningham Recreation
[.g_J D Check this box if you are flllng 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.)
Name of local government officer about whom the information in this section Is being disclosed.
NA
Name of 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 local government officer named in this section receiving or likely to receive taxable income, other than investmentincome, from the vendor?
Oves [Z] No
B.Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the localgovernment officer named in this section AND the taxable income is not received from the local governmental entity?
Oves [Z] No
c.Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the localgovernment officer serves as an officer or director, or holds an ownership interest of one percent or more?
Oves [Z]No
D.Describe each employment or business and family relationship with the local government officer named in this section.
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�c,�l �1/9/2024
Signature of vendor doing business with the governmental entity Date
HPS New Vendor Package_v.5.31.22R_P",l!g0'1,?tJ081712015