HomeMy WebLinkAboutCable Electric, Inc. 2023CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ
For vendor doing business with local governmental entity
This questionnaire reflects changes made to the law by H.B. 23, 84th Log., Regular Session.
OFFICIELISECINLY
This qUeStiOurlalre is being filed in accordance with Chapter 176, Local Government Code, by a vendor who
Dire Received
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 will) the records administrator of the local governmental entity not later
than ilia 7V) business day after the date the vendor becomes aware of facts trial reqUile the statement to be
filed, See Section 176.006( @ -1), Local Government Code
A vendor commits an offense if the vendor knowingly violates Section 176.00e, Local Government Code. An
offense under this seciJon is a misdemeanor.
Name of vendor who has a business relationship with local governmental entity.
L
:2Ffr'-i Check this box if you are filing an update to a previotf Sly filed quest! onnaire. (The law requires that you file an updated
completed questionnaire with the appropriate filing authority not later than the 7th business day alter the date on whroll
you became aware that the originally filed questionnaire was incomplete Or inaccurate
:31 Name of local government officer about whomthe information is being disclosed.
Warne of Officer
1J 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 tile 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 larrilly member of the officer receiving OIL likely to receive taxable income,
other than investment income, from the vendor?
El Yes [Z Nc
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 from the
local governmental entity?
71 Yes No
describe each employment or business relationship that tile vendor named inSeclon I maintains with corporation or
other business entity with respect to which the local government officer serves as an officer or director, or fields an
ownership interest of one percent or more.
ElChec� fts box if the venor has given the local government officer or a family member of the officer one or more gifts
as described in Shenandoah 003(a)(2)(B), excluding gifts described in Section 176,003(,a -1).
ij
`° .. SrUre)f vendor doing bpelness 'tjl the governmental entity I DaA
Form provided bykTgrt,,v,ethics Comrrisslciw Www.ethlcs.Stat8.IX.US Revised 11/3012015
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