3-03 - Conflict of Interest Questionnaire.pdf

This document is a Conflict of Interest Questionnaire (Form CIQ) for vendors or other persons conducting business with a local governmental entity. The form is designed to comply with Chapter 176 of the Local Government Code and must be filed when a person has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and meets the requirements under Section 176.006(a). The questionnaire must be filed with the records administrator of the local governmental entity no later than the 7th business day after the person becomes aware of facts requiring the statement to be filed, and violations constitute a Class C misdemeanor under Section 176.006 of the Local Government Code.

The form requires disclosure of the name of the person with a business relationship with the local governmental entity and the name of the local government officer with whom the filer has an employment or business relationship. It includes detailed questions about whether the local government officer receives taxable income from the filer, whether the filer receives taxable income from or at the direction of the officer, and whether the filer is employed by a corporation where the officer serves as an officer, director, or holds 10 percent or more ownership. The form requires a signature and date from the person doing business with the governmental entity and was adopted on 06/29/2007.