HomeMy WebLinkAboutServer Suites LLC CIQ 12.11.25GONFLICT 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 nreets requirements under Sectiorr 176.006(a) and by City of Denton
Ethics Code, Ordinance 1B-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 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.
Name of vendor who has a business relationship with local governmental entity.
4 o a-uc (a 3 *."4"1 Lr-C
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later
after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
than the 7ri' business day
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- | Check this box if you are filing an update to a previously filed questionnaire.Jtr
! j \anr,, ol locrrl govcrurncut olliccr ill)out \\'hoiu thc inlilrrnlliou in lllis scc(ion is hcirtg <lisclosetl.
Name of Officer
Attaoh additional pages to this Form ClQ as necessaty.
- "., K,,
this sectiou AND the taxable income is not received from the local govemureutal entity?
Yes
or tlirector, or holds arr orvuership of otle percent or ntole?
Yos
I). I)cscr.ibc caoh cnployntent or busincss and lhnrily rclationship u'ilh (hc local govcnrrcnt of'liccr nanred in (his scction.
EE
E
4 K, n^u.no conflict of lnterest to disclose.
:l ,ll ,r\e 5
Datcbusiness u'i1[r the govelnrnental entity
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