AAdvantage Laundry Systems CIQ 8-2-2024FORM CIQQUESTIONNAIRE
with IdoiFor vendor or other b
CONFLIGT OF INTEREST
has a business relationship as defined
under Section 176.006(a).
later than the 7th business day after the
176.006(a-1), Local Govemment Code
An offense under this section is a
By law this questionnaire must be filed with the records administrator of the local govemment
Uate tne vendor becomes aware of facts that require the statement to be filed' See
A vendor commits an offense if the vendor knowingly violates Section '176'006, Local
misdemeanor.
Leg.,questionnaire
This
by
changes made to the law by H.8.23,
questionnaire is being filed in
Section 176.001(1-a) with
byGovernmentCode,Local76,with Chapteraccnrdance meetsvendortheandlocalentitygovernmental
has a busineasof vendor with
2
not later than the 7h business daY
inaccurate.)
L-l Check this box if you are filing an update to a previously filed questionnaire.
thewith appropriatethatanfilequestionnairecompletedupdatedlawrequiresyou(The wasfiledawarebecamethethatquestionnaireondateoriginallywhichtheyouafier
Name of local government officer about whom the information in this section is t eing disclosed.
Name of Officer
officer, as described by Section
subparts A, B, C & D), must be
I 76.00 1 ( 1-a), Local Government Code.
income, from the vendor?
of the local govemment officer named in
government of;ticer serves as an ofFtcer
A. Is the local govemment officer named in this section receiving or likely to receive taxable inoome, other
Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the
this section AND the taxable income is not received from the local governmental entity?
C. Is the filer ofthis questionnaire employed by a corporation or other business entity with respect to which
or director, or holds an orrnership of one percent or more?
D. Describe each employment or business and family relationship with the local government officer named
No
B
No
Yes
Yes
Nol--l ".,
4 I have no Conflict of lnterest to disclose.
5 2
Datewith the governmental entitySignature
a
as defined
between two or more Parties
governmental entitY or an
a state or federal agencY and
e local government officer or a
member receiving taxable
during the 12-month Period
vendor has been executed;
ng into a contract with the
of the officer one or more gifts
period preceding the date the
vendor has been executed; or
a contract with the vendor,
has a business relationshiP
officer of that local
176.003(aX2)(A);
or a family member of the
76.003(aX2XB), excluding any
governmental entity.
records administrator
with the local governmental
to a request for proposals
contract with the tocal
,local government officer, or a
Subsection (a);or
to a vendor if:
entity
.us/
based on
or
CONFLICT OF INTEREST
For vendor doing business with local
A complete copy of Chapter 1 76 of th Local Government Code may be found at
DocsllG/htm/LG.76.htm For easy reference,below are some of the sections
Local government Code S 176.001(1'a):
based on commercial activity of one of the
"Business relationsh ip"means a
parties The term does not include a
(A)a transaction that IS subject to rate or fee regulation by a federal
agency of a federal state,or local governmental entity;
(B)a transaction conducted at a price and subject to terms available to
(c)a purchase or lease of goods or services from a person that ls
that rs subjecl to regular examination by and reporti ng thal agency.
Local Government Code $ 176.003(aX2XA) and.(B):
(") A l"cal government officer shall file a conflicts disclosure statemenl
(2)the vendor:
(A)has an employment or other business relationship
family member of the officer that resuIts in the officer
incomg,other than investment ncome that exceeds
precedi ng the date that the olficer becomes aware that
(i)a contract between lhe local governmental
or
(ii) the local governmental entity is
vendor;
(B) has given to the local government officer or a family
that have an aggregate value of more than $100 in the 1
officer becomes aware that:
(i) a contract between the localgovernmental entity
(ii) the local governmental entity is considering
LocalGovernment Code $ 176.006(a) and (a'1)
(a) A vendor shall file a completed conflict of interest questionnaire if the
with a local governmental entity and:
has an employment or other business relationsh ip with a
governmental entity, or a family member of the officer,
(2) has given a local government officer of that local r
described
officer, one or more gifts with the aggregate value specified by
gift described by Section 176.003(a-1); or
(3) has a family relalionship with a local government officer o{
(a-1) The completed conflict of interest questionnaire must be fited with
not later than the seventh husiness day after the later of :
(1) the date that the vendor:
(A) begins discussions or negotiations to enter into a
entity;or
(B) submits to the localgovernmental entity an
or bids, correspondence, or another writing related to
governmental entity; or
(2) the date the vendor becomes aware:
(A) of an employment or other business relationship
family member of the officer, described by Subsection
(B) that the vendor has given one or more gifts
(C) of afamily relationship with a local government
Revised 1113O12A15Form provided by Texas Ethics Commission www.ethics.state.lx.us
this form.
to,
(1 )