Groggy Dog CIQ 07.31.2024CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other person doing business with local governmental entity
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 fled with the records administrator of the local government entity not later than the 71h business day after the
date the vendor becomes aware of facts that require the statement to be filed. See Section 176M(ffe-1), Local Government Cade.
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.
Groggy Dog Sportswear & Graphic Design, LLC
2
Check this box If you are filing an update to a previously glad questionnaire.
The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 711 business day
after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Nameof local aovernment omeer a bout whom the efiarmatlon in this section is being disclosed.
N/A
Name of Officer
Describe each employment or other business relationship with the local government officer, or a family member ofthe officer, as described by Section
176.003(a)(2)(A). Also describe any family relations bip with the local govemment officer. This section, (item 3 including subparts A, B. C & D), must be
completed for each officer with wham the vendor has no employment or other business relationship as defined by Section 176.001(1-a), Local Govemment Code.
Attach additional pages to this Form CIO as necessary.
A. Is the local gowniment officer named in this section receiving or likely to receive taxable income, other than investment income, from the vendor,
0 0 N/A
Yes No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer named in
this section AND the tenable income is not received gam the foal governmental entity.,
Yes = No N/A
C. lithe filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as anofficer or
director, or holds an ownership atone percent or mom? N/
A OOYesNoD.
Discount each employment or business mid family relationship with the local government officer named in this section. N/
A 4
1
have no Conflict of Interest to disclose. am
LI Sigv
eof dor doing business with the governmental entity Date