Durable Specialtites Inc CIQ 04.30.2025CONFLICT OF INTEREST QUESTIONNAIRE
CONFLICT OF INTEREST QUESTIONNAIRE -FORM CIQ
For vendor or other business with local rnmental endoi
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(l-a) with a local govemmental 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 government e[tity 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-l), Local Govemment Code,
A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Govemment Code. An offense under this section is a
misdemeanor.
I Namr of vcndor rho hrr a business relttionrhip with locrl governmental entity,
D,^.r
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(The law requires that you file an updated complctcd questionnaire with the appropriate flling authority not later than the 7rh business
tr
day after rhe
or lnaccuratedate on which uestionnaire was ibecame aware that the inal filed
Che.k this box ifyou are flling rn updrte to a previourly nled questionnf,ire.
I Name ollocal govcrnmcnt omcer rbout whom the information in this section is being disclosed.
Name ofofllcer
This section, (item I 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( l-a), Local Covemment Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local govcmment oflicer named in this section receiving or likely to receive taxable income, othcr than investmeht income. from the vendor?
No
ts ls the vendor receiving or Iikely !o reccive taxable income, other than investment income, from or at the dircction of the local govemment officer
named in this section AND the taxable income is nor received from the local govemmental entity?
Yes No
C ls the filer ofthis questionnaire employed by a corporation or other business entity with respect to which the local govemment officer serves as anofficcr or director, or holds an ownership of one perccnt or more?
Yes No
D. Describe each employment or business and family relationship with the local go!emment officer named in this section
1 X I have no Conflict of Interest to disclose.
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Signature of vendor doing business with the govemmentsl entity Date
3o eo 75