HomeMy WebLinkAboutMister Red LLC CIQ 01.13.26CONFLICT OF INTEREST QUESTIONNAIRE FORMCIQ
For vendor or other rson doin business with local ovemmental en • 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).
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-t), 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 amisdemeanor.
1 Name of vendor who has a business relationship with local governmental entity. tJ ( {:\
2 D Check this box if you are filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questiomaire with the appropriate filing authority not tater than the 7'1' business dayafter the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)
3 Name of local gowrnment officer about whom the information in this section is being dlsdosed.
Name of Officer
Dmoribe each employment er other business .n:latiansrup with the local government officer, or a mmily member of the officer, as described by Section l 76.003(aX2)(A). Also desoribc any family relatiODS hip with the local government officer. This slllllion, (item 3 including subparts A, B, C & D), must be oomplw:d for each offillCl-with whom the vendor has an employment <ll" other business relationship as defined by Section 176..001(1-a), Local. Government Code. Attaah additiooal pages to lhi.� Farm CIQ as necessary.
A. & th IOCl'I! gowmmcm. offiD Yes
1'lllfflCd in this t=m11g or-tikclyto n=m,1'1.'<llble inctime, <llffl:!""
�No
Bncsln1c1lt dlCffll!C, Imm 1hevcndor-?
B..& th:r; "'"da tceci,mgorlib:fyton:cci=tn:zrbfeim::omc, othcr-thati inocsbntad int,,.,m,;, fi:om oratfhedirc,,tio,roffhek,c:,,f go,muucot .,ffie,:r-mnm:,finthis scctianANDtbc taabk: .in.cone is alll�a:l.fmm. the b>a1 � coti1y'I D Yes rnNo
C.Is lhe filer of this questionnaire employed by a oorpomtioo or other business entity with respect to whu:h lhe looal government off10ec scives as an officerm dm:am;, or..W. -hiip nf am: pm:,cat ...-mam.1
D Yes [R)No
D.Describe each employment or business and family relationship with the local government officer named in this section.
4 � I have no Conflict of Interest to disclose.
5