CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person doing business with
local governmental entity
 FORM CIQ
This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person doing business with the government entity. OFFICE USE ONLY
Date Received
By law this questionnaire must be filed with the records administrator of the local government  not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. 
See Section 176.006, Local Government Code
A person commits an offense if the person violates Section 176.006, Local Government Code.  An offense under this section is a Class C misdemeanor.
1     Name of person doing business with local government entity

 
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2         Check this box if you are 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 September 1 of the year for which an activity described in
          Section 176.000(a), Local Government Code, is pending and not later that 7th business
          day after the date the originally filed questionnaire becomes incomplete or inaccurate.)
3       Name each employee or contractor of the local government entity who makes   
          recommendations to a local government officer of the government entity with
          respect to expenditures of money AND describe the affiliation or business relationship.
 
 
 
 
 
 
 
 
 
 
4       Name each local government officer who appoints or employs local government officers
         of the governmental entity for which this questionnaire is filed AND describe the affiliation
         or business relationship