HomeMy WebLinkAboutJR WEST TEXAS CONCRETE, LLC 2023CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For venclor doing business with, locall governmental entlty
This questionnaire refloots changes made to the taw by H.B. 23, 84th Leg., Regular Sessiton. OFFICE USE ONLY
This qtyestionnai�o is being Mad ni nccord,,.irv.e mliti Cl-kipter 176, LocaJJ GovellnMeM Code by a vendor who NtR PGrqiV;Xj
has a business relationd�p as d8fin id by Section 176. 00 1 (1 -a) Mth a loca� gQvernmenW entity and the
vendor meets requirements under Section 176,00e(a),
By law this questionnaire must be filed widi tfie reco�ds administratot of die locall govarnirnentar entry not ato
than the 7th business day afler the date the venclor becornes awate 0 facts that req0ro Vie to b
filed, See Section 176.006(a- I �, Local Government Code,
OfiellSO Under this section is a misdemeanor.
Name of vendor who has a business relationship with local governmentatl entity,
JR WEST TEXAS CONCRETE LLC
�2 0 Check thris box if you are filing an update to a previously filed questionnaire, (The law requires that you fitean updated
completed questbnnaire with the appropriate filing arAhority not laler, than the 711h business day after, the date on which
you e arr* aware that the originaUy filed questionnaire was incomp�ete or Inaccurate,)
Wants of local government officer about whom the Information is being disclosed.
:43 Describe each employment or, other business r0afionship with the local government officer, or a familly member of the
officer, as dlescribed by Section IM003(a)(2)(A). Also describe any family relationship with the local government officer.
Complete subparlis A and B for each employment or business relationship described. Attach additional pages to this Form
CIQ as necessary,
A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income,
other thai investment incorne, from the vendor"e
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 larnf[y rinember ot the officer AND the taxable income is not received from the
local governmental entity?
Yes No
Ex
Describe each employment or business relationship that the vendor narned! in Section I maintains with a corporation or
other business entity with respect to which the local government officer serves as an officer ot director, or holds an
ownership interest of one percent or more.
.�j Check this box �f the vendor has given the roca I govern ment officer or a fan'iiiy inernber of the officer one or more gifts
as described in SeO�oin 176 003(a)(2)(8), excludiing g4ts described in Section 176 003(a-1)
Form provided t&L-� s Commission WWW erhiCS SNIteAX.US Revised 1 V301V 15
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