1-Conflict of Interest Questionnaire.pdf

PDF 707 KB Posted

Attached to
Stop Loss Reinsurance for Partially Self-Funded Medical and Prescription Health Plans
Solicitation number
HR-01-26
Issued by
Travis County, Texas

About this file

This document is a Conflict of Interest Questionnaire from the City of San Angelo, Texas Purchasing Division, located at 72 West College Avenue, San Angelo, Texas 76903. The form is designed for vendors doing business with the local governmental entity and reflects changes made to the law by H.B. 23, 84th Legislature, Regular Session. The questionnaire requires vendors to disclose any potential conflicts of interest with local government officers or their family members, including business relationships, transactions, or income that might create a conflict.

The document outlines specific reporting requirements under Local Government Code Sections 176.006(a) and 176.003(a), which mandate disclosure of employment relationships, business connections, or gifts involving local government officers or their family members. Vendors must complete the form if they have a business relationship with the local governmental entity, detailing any transactions, employment relationships, or potential financial interactions that could be perceived as a conflict of interest. The form must be filed with the local government records administrator not later than the seventh business day after the date the vendor becomes aware of the need to file the questionnaire.

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CITY OF SAN ANGELO, TEXAS

PURCHASING DIVISION

72 West College Avenue, San Angelo, Texas 76903

325.657.4219 • sapurch@cosatx.us

CITY OF SAN ANGELO, TEXAS • CONFLICT OF INTEREST QUESTIONNAIRE

Conflict of Interest Questionnaire

PLEASE NOTE: If you do not have any Conflict of Interest(s) to report, please write “N/A” in Box 1 and complete Box 7 with signature and date.

mailto:sapurch@cosatx.us

CITY OF SAN ANGELO, TEXAS

PURCHASING DIVISION

72 West College Avenue, San Angelo, Texas 76903

325.657.4219 • sapurch@cosatx.us

CITY OF SAN ANGELO, TEXAS • CONFLICT OF INTEREST QUESTIONNAIRE

mailto:sapurch@cosatx.us

Conflict of Interest Questionnaire

File details come from the government source that posted it. Updated .