2-RFQt-02-CIQ Form.pdf
PDF 466 KB Posted
- Attached to
- RFQt Grading Services State and local contract opportunity
- Solicitation number
- 25-0228
- Issued by
- Tarrant County, Texas
About this file
This is a Conflict of Interest Questionnaire (CIQ) form for the City of Fort Worth's Purchasing Division related to RFQt #25-0228 for Grading Services. The document serves as a mandatory disclosure form that must be completed by any person or agent seeking to contract with the City of Fort Worth, pursuant to Chapter 176 of the Local Government Code. The questionnaire must be filed with the City Secretary no later than seven days after contract discussions begin or when submitting an application, response, or other correspondence related to a potential agreement with the City.
The form requires vendors to disclose any business relationships or affiliations that might create a conflict of interest with the local governmental entity. Key sections include identification of local government officers with whom there may be business relationships, disclosure of employment or business connections, and details about any gifts or benefits exchanged. The document emphasizes that compliance is an individual responsibility, with violations constituting a Class C misdemeanor. For vendors without conflicts of interest, they should enter their proposer name in section 1, use "N/A" for other areas, but must still provide a signature in section 7. The form is also available online through the Texas Ethics Commission website for additional reference.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 5-RFQt-05-Scope of Service.pdf | ||
| 8-Addendum.pdf | ||
| 4-RFQt-04-Reference Sheet.pdf | ||
| 6-RFQt-06-Questionnaire and Requirements.pdf | ||
| 7-RFQt-07-Draft Vendor Services Agreement.docx | DOCX document | |
| 1-RFQt-01-Instructions to Bidders.pdf | ||
| 3-RFQt-03-Authorized Signature and Contact Details.pdf |
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
RFQt Ref. #: 25-0228 Doc. Ref#: RFQt-02 Page 1 of 3 RFQt Title: Grading Services
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. #: 25-0228 Doc. Ref#: RFQt-02 Page 2 of 3 RFQt Title: Grading Services
RFQt Ref. #: 25-0228 Doc. Ref#: RFQt-02 Page 3 of 3 RFQt Title: Grading Services
File details come from the government source that posted it. Updated .