3-Attachment 2 - CIQ.pdf

This document is a Conflict of Interest Questionnaire (Form CIQ) for vendors or individuals doing business with a local governmental entity, as mandated by H.B. 1491 from the 80th Legislative Session. The form is designed to 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 statement, in accordance with Chapter 176 of the Local Government Code. A person who knowingly violates this requirement commits a Class C misdemeanor.

The questionnaire requires detailed disclosure of business relationships between the filer and local government officers, including whether the filer or their entity is receiving or likely to receive taxable income from the local government entity, or if the filer is employed by a corporation in which the local government officer serves as an officer or director, or holds an ownership stake of 10 percent or more. The form must be completed for each officer with whom the filer has an employment or business relationship, with sections for affirming various potential conflicts of interest. The document was adopted on 06/29/2007 and provides space for the filer's signature and date of submission.