13-3. Conflict of Interest Form.pdf

PDF 1 MB Posted

Attached to
Construction of Woodland West Aquatic Center
Solicitation number
26-0071 & PJPKPL24005
Issued by
Tarrant County, Arlington City, Texas

About this file

This is a Conflict of Interest Questionnaire (CIQ) form issued by the City of Arlington, Texas, Office of Procurement, required for parties seeking to contract with the City of Arlington for the sale or purchase of property, goods, or services. The form is mandated under Chapter 176 of the Local Government Code and applies to all vendors and bidders, including those responding to the Construction of Woodland West Aquatic Center solicitation. Vendors must disclose any affiliations or business relationships that might create a conflict of interest with the City. The CIQ form requires proposers to provide their company name, identify any officers or business entities with which they have relationships, and describe employment or business connections to corporations or entities in which local government officers serve as officers, directors, or hold ownership interests of one percent or more. All vendors must sign the form regardless of whether they have identified conflicts; submission of an incomplete or unsigned form may result in bid non-compliance.

The form is available through the Texas Ethics Commission website at https://www.ethics.state.tx.us/forms/conflict/ and must be completed and submitted with bid responses. Vendors unaware of any conflicts of interest should enter "N/A" in the applicable sections while providing their proposer name and required signature. The CIQ is a mandatory compliance document with no alternative submission methods; failure to properly complete and submit the form may affect bid eligibility for the Woodland West Aquatic Center construction project or any other City of Arlington procurement opportunity.

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CITY OF ARLINGTON - OFFICE OF PROCUREMENT

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)

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 Arlington) 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. 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/

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/

Project Number: Page 2 of 3 Project Title:

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
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 ca...
Project Title:
lJ Nlame ot vendor who has b11siness retatianshipwiU1 locrl govemmemal Qnlity:
Name oi Officer:
w Describe each employment or busi11ess 1Nlaticmshp th 1 the VQndor 1named in Section 1 mai11tai11s wilh a corporation or o1her business Qn1i1y wi1h respect to wihich 1he local govemment officer serves as 11 offioer or directo or holds 11n ownership interest of ooo pefcent or more:
Text1:
Text2:
Text3:
Text4:
Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off

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