HomeMy WebLinkAboutMears, Erin CIQ 08.21.26CONFLICT OF INTEREST QUESTIONNAIRE - FORM CIQ
For vendor or other arson dining business with local overnmental anti
This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.
This questionnaire is being filed in accordancewith Chapter 176, Local Govemment 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, Or 18-757.
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.
1
Name of vendor who has a business relationship with local governmental entity.
2
❑ Check this box if you am filing an update to a previously filed questionnaire.
(The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7' business day
after the date on which you became aware that the originally filed quesfionnaire was incomplete or inaccurate.)
3 Name of local government officer about wham the information in this section is being disclosed.
Name of Officer
Describe each employment or other business relationship with the local government: officer, car a family member of the officer, as described by Section
176.003(a)(2)(A). Also describe my family relations hip with the local government officer. This section, (item 3 including subparts A. B, C & D), m t be
completed for each officer with whom the vendor has an employment or other business relationship as delved by Section 176.001(1a), Local Government Code.
Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving car likely to receive taxable income, other than investment income, from the vendor?
Fkc[No
Yes
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the drtecdon of the local government officer named in
this section AND the taxable income is not received from the local governmental entity?
ED Yes No
i�
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local government officer serves as an officer
or director, or holds an ownership of me percent or more?
ED P!! No
Yes
D. Describe each employment or business and family relationship with the local government officer named in this sectiom
N /A
4
1 haw no Conflict of Interest to disclose.
071 rl/
Signature of vendor doing business with the governmental entity n„r'