HomeMy WebLinkAboutMcClendon Construction Company, Inc 2023CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 841h Log., Regular Session. OFFICEUSEONLY
Ibis questionnaire is being filed in accordance ievith Chapter 176, Local Government Code, by a vendor who Date Received
has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the
vendor meats requirements Under Section 176.006(a).
By law tills questionnaire must be filed With the records administrator of die focal governmenial entity not later
than the 7h business day after the data the vendor becomes aviare of facts that require trie statement to be
filed See Section 176r0061a-1), Local Government Code.
A vendor commirs, all offense if tl'P vendor knovhigCy violates Section 176,006, Local Government Code. An
offense under this section is a misdemeanor.
1J Name of vendor who h s a business relationship with local governmental entity.
7'1�
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Check thus box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated
EI 's
completedcluestbimaire with the appropriate filing authority not later than the 71h business day after the date on which
you became aware that the originally filed questionnaire was incomplete or inaccurate.)
Name of local government officer about whom the information is being disclosed.
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Narne of Officer
Describe each employment or other business relationship with the local government officer, or a family 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 government officer or a family member of the officer receiving or likely to receive taxable income,
other than investment income, frorn the vendor?
17-1
L-j Yes EJ No
B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction
of the local government officer or a family member of the officer AND the taxable income is not received Irorn the
local governmental entity?
Yes El No
Describe each employment or business relationship that the vendor named in Section 1 maintains with 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.
P P
1 1
Check this box if the vendor has given the local government officer or a farn fly member of the officer one or more gifts
as de s in Section 176.003(a)(2)(3), eXCILidi gif escribed in Section 176.003(a-1).
14 . Cl
Signature of vendor doing business with the governmental arility Date
Form provided by Texas Ethics Commission wwmelhics.state.tx Lis Revised 111012015
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