HomeMy WebLinkAboutARTEX OVERHEAD DOOR CO 2023CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by 1-18. 23, 84th Leg., Regular Session.
OFFICE USE ONLY
This qL10SUOrIn-Elile is being filed in accordance wilh Chapter 176, Local Government Code, by a vendor who
Datp Rpceived
has a IXISiness relal a� defined by Section 176.001(1-a) with a local 9OVeMmental entity and die
vendor meets �PqLrrerrerit* under Section 176.006(@)
By law this (jUeS60111alr-e MUSt be Ned Min the �acords adminlsirator of the local governmewal entity riot later,
Him the 7th IbUdileSS day after the date the vendor becomes aware of facts that equire gie statement to be
filed. See Section 176 006,"a-1), Local Governmert Code.
A vandor commits an offerrse if die vendor knowingly violates Section 176 006, Local Goveirmprit Code. An
offense under this section is a misdemeanor.
Name of vendor who has a business relationship with local governmental entity.
Check this box if you arefiling an update to a previously filed questionnaire, (The law requires that you file an updated
completed questionraire wl1h the appropriate fjl�ng authority not later than the 71h business day after the data on which
you became aware that the originaily filed questionnaije was incornictete or �naccurate
2J Name of local government officer about whomthe information is being disclosed.
Name of Officer
:41 Describe each empl 11 oyment or other business relationship with the local government officer, or a fannHy member of the
officer, as described by Section 176.003(a)(2)(A) Also describe any family relationship with the local government officer.
Complete subparts A and B for each employment or business relationship described. Attach additional! pages to this Form
CIO as necessary,
A. Is the local goVerninent officer or a family inernber of the officer receiving or likely to receive taxabfe irccrne,
other than investirent Income, frorn the vendor?
L] Yes El No
13, Is the vendor receiving or likely to receive taxable incorne, c1her than Investment Income, frorn or at the direction
of the local government officer or a famiilly inernber of the officer AND the taxable Income is not received fiorn the
local goverrimental entity?
Describe each employment or business relationship that the vendor named in Section I maintains with a corporation or
other business entity with respect to which the local government officer serves as an officer or director, or holds an
ownership interest of one percent or more,
ElCheck this box if the vendor has giver the local government officer or a farnfly nnernber of the officer one m tinore gifts
as described n Section 176.003(a)(2)(P), excluding gifts described in Section 176 003(a-1)
Sig
Vure 6f vendot doing busiress with the governmental entity Date
Faim provided by Tpxas E'thics Commission 'PVWW ethics StateA Lis Revised 11/M2015
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