1-ITB-02-CIQ Form.pdf
PDF 408 KB Posted
- Attached to
- Water Meter and Pump Gaskets
- Solicitation number
- 25-0204
- Issued by
- Tarrant County, Texas
About this file
This document is a Conflict of Interest Questionnaire (CIQ) issued by the City of Fort Worth Purchasing Division for an Invitation to Bid (ITB) referencing project number 25-0204 for Water Meter and Pump Gaskets. The CIQ is a mandatory form pursuant to Chapter 176 of the Local Government Code, which requires any person or agent seeking to contract with a local governmental entity to disclose potential conflicts of interest. The document outlines the legal requirements for vendors, including the need to file the questionnaire within seven days of beginning contract discussions or submitting a bid response.
The form requires vendors to provide detailed information about any business relationships with local government officers, including potential financial connections, employment relationships, or gift exchanges that might constitute a conflict of interest. Vendors must complete various sections detailing any employment or business relationships with local government entities, potential income sources, and connections to government officers or their family members. The document emphasizes that compliance is an individual responsibility, and failure to properly disclose potential conflicts could result in a Class C misdemeanor. The Texas Ethics Commission provides the form, which must be filed accurately and signed by the vendor.
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
ITB Ref. #: 25-0204 Doc. Ref#: ITB-02 Page 1 of 3 ITB Title: Water Meter and Pump Gaskets
Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person who contracts or seeks to contract for the sale or purchase of property, goods, or services with a local governmental entity (i.e. City of Fort Worth) must disclose in the Conflict of Interest Questionnaire Form “CIQ” the person’s affiliation or business relationship that might cause a conflict of interest with the local governmental entity. Bylaw, the Questionnaire must be filed with the City of Fort Worth Secretary no later than seven days after the date the person begins contract discussions or negotiations with the City or submits an application or response to a request for proposals or bids, correspondence, or another writing related to a potential agreement with the City. Updated Questionnaires must be filed in conformance with Chapter 176.
A copy of the Questionnaire Form CIQ is enclosed with the submittal documents.
The form is also available at https://www.ethics.state.tx.us/forms/conflict/
If you have any questions about compliance, please consult your own legal counsel.
Compliance is the individual responsibility of each person or agent of a person who is subject to the filing requirement. An offense under Chapter 176 is a Class C misdemeanor.
NOTE: If you are not aware of a Conflict of Interest in any business relationship that you might have with the City, state the Proposer name in # 1, and use N/A in each of the areas on the form. However, a signature is required in the #7 box in all cases.
https://www.ethics.state.tx.us/forms/conflict/
ITB Ref. #: 25-0204 Doc. Ref#: ITB-02 Page 2 of 3
ITB Ref. #: 25-0204 Doc. Ref#: ITB-02 Page 3 of 3
File details come from the government source that posted it. Updated .