1-RFP-02-CIQ Form.pdf
PDF 437 KB Posted
- Attached to
- RFP Automated Temperature Monitoring System
- Solicitation number
- 25-0163
- Issued by
- Tarrant County, Texas
About this file
This document is a Conflict of Interest Questionnaire (CIQ) from the City of Fort Worth Purchasing Division for an Automated Temperature Monitoring System, with a Request for Proposal (RFP) reference number 25-0163. The document outlines legal requirements under Chapter 176 of the Local Government Code, which mandates that any person or agent seeking to contract with a local governmental entity must disclose potential conflicts of interest. Vendors must file the questionnaire within seven days of beginning contract discussions or submitting a proposal, and must update the form if any relevant information changes.
The form requires vendors to provide details about their business relationships with local government entities, including potential financial interactions, employment connections, or gift exchanges that might constitute a conflict of interest. Specifically, vendors must declare any business relationships where they or a family member of a government officer might receive taxable income, have an ownership interest, or have given gifts above a certain threshold. The document emphasizes that compliance is an individual responsibility, and failure to properly disclose potential conflicts could result in a Class C misdemeanor. The form is provided by the Texas Ethics Commission and was last revised in November 2021.
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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.
https://www.ethics.state.tx.us/forms/conflict/
RFP - CIQ RFP Ref. #: 25- Page 2 of 3
RFP Title:_________________________________________________________
RFP - CIQ RFP Ref. #: 25- Page 3 of 3
RFP Title:_________________________________________________________
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| Text4: Automated Temperature Monitoring System |
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| Text6: Automated Temperature Monitoring System |
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| Text8: Automated Temperature Monitoring System |
File details come from the government source that posted it. Updated .