1-RFP-02-CIQ Form.pdf
PDF 456 KB Posted
- Attached to
- RFP Emergency Pipe Repair Materials and Services State and local contract opportunity
- Solicitation number
- 25-0164
- Issued by
- Tarrant County, Texas
About this file
This is a Conflict of Interest Questionnaire (CIQ) form from the City of Fort Worth's Purchasing Division for RFP Reference #25-0164, titled "Emergency Pipe Repair Materials and Services." The three-page document is a mandatory disclosure form that must be completed by any person or entity seeking to contract with the City of Fort Worth for the sale or purchase of property, goods, or services. The questionnaire must be filed with the City Secretary within seven days of beginning contract discussions, negotiations, or submitting a proposal response, as required under Chapter 176 of the Local Government Code.
The CIQ form requires vendors to disclose any business relationships or affiliations that might create a conflict of interest with the local governmental entity. The questionnaire includes sections for identifying the vendor, describing employment or business relationships with local government officers, detailing financial interests, and disclosing any gifts provided to city officials or their family members. Vendors who are unaware of any conflicts of interest may simply state their company name and mark "N/A" in applicable areas, though a signature is still required. Non-compliance with Chapter 176 filing requirements constitutes a Class C misdemeanor, and the form emphasizes that compliance is the individual responsibility of each person subject to the filing requirement.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 7-RFP-06-Evaluation Factors and Scope of Services.pdf | ||
| 3-RFP-05-Draft Services Agreement.pdf | ||
| 5-RFP-01-Instruction to Proposers (1).pdf | ||
| 8-Addendum 2- RFP 25-0164 Emergency Pipe Repair Materials and Services.pdf | ||
| 2-RFP-03-Authorized Signature and Contact Details.pdf | ||
| 4-RFP-04-Reference Sheet.pdf | ||
| 6-RFP-07-Questionnaire and Requirements.docx | DOCX document |
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
RFP - CIQ RFP Ref. #: 25- Page 1 of 3
RFP Title:_________________________________________________________
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
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.
Emergency Pipe Repair Materials and Services
RFP - CIQ RFP Ref. #: 25- Page 2 of 3
RFP Title:_________________________________________________________
RFP - CIQ RFP Ref. #: 25- Page 3 of 3
RFP Title:_________________________________________________________
File details come from the government source that posted it. Updated .