2-RFQt-02-CIQ Form.pdf
PDF 448 KB Posted
- Attached to
- RFQt Scantron State and local contract opportunity
- Solicitation number
- 25-0227
- Issued by
- Tarrant County, Texas
About this file
This document is a Conflict of Interest Questionnaire (CIQ) form required by the City of Fort Worth Purchasing Division for RFQ Reference #25-0227 titled "Scantron." The document serves as a mandatory disclosure form that any person or agent seeking to contract with the City of Fort Worth must complete pursuant to Chapter 176 of the Local Government Code. The questionnaire must be filed with the City of Fort Worth Secretary no later than seven days after contract discussions begin or a response is submitted. The form requires vendors to disclose any affiliations or business relationships that might cause a conflict of interest with the local governmental entity.
The CIQ form includes sections for vendors to identify potential conflicts including employment or business relationships with local government officers, family relationships, gift disclosures, and ownership interests. Vendors must complete all applicable sections or mark "N/A" where no conflicts exist, though a signature is required in all cases. The document emphasizes that compliance is the individual responsibility of each person subject to the filing requirement, with violations constituting a Class C misdemeanor. The form is provided by the Texas Ethics Commission and includes detailed definitions of business relationships and disclosure requirements under Local Government Code sections 176.001 through 176.006.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 1-RFQt-01-Instructions to Bidders.pdf | ||
| 5-RFQt-05- Scopes of Service.pdf | ||
| 4-RFQt-04-Reference Sheet.pdf | ||
| 7-RFQt-07-Draft Vendor Services Agreement.docx | DOCX document | |
| 3-RFQt-03-Authorized Signature and Contact Details.pdf | ||
| 6-RFQt-06-Questionnaire and Requirements.pdf |
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
RFQt Ref. #: 25-0227 Doc. Ref#: RFQt-02 Page 1 of 3 RFQt Title: Scantron
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. By law, 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.
RFQt Ref. #: 25-0227 Doc. Ref#: RFQt-02 Page 2 of 3 RFQt Title: Scantron
RFQt Ref. #: 25-0227 Doc. Ref#: RFQt-02 Page 3 of 3 RFQt Title: Scantron
File details come from the government source that posted it. Updated .