3-ITB-02-CIQ Form.pdf
PDF 695 KB Posted
- Attached to
- ITB Asphalt Hot and Cold Lay
- Solicitation number
- 25-0156
- Issued by
- Tarrant County, Texas
About this file
This document is a Conflict of Interest Questionnaire (CIQ) from the City of Fort Worth Purchasing Division for Invitation to Bid (ITB) Reference #25-0156, titled "Asphalt Hot and Cold Lay". The document outlines the legal requirements for vendors doing business with the local governmental entity, specifically detailing the disclosure obligations under Chapter 176 of the Local Government Code. Vendors must complete this form to transparently report any potential conflicts of interest, including business relationships with local government officers or their family members that could impact the bidding or contracting process.
The CIQ requires vendors to disclose employment or business relationships that might create conflicts of interest, such as receiving taxable income exceeding $2,500 from the local government entity within a 12-month period, or receiving gifts valued over $100 from the vendor. The form must be filed within seven business days of beginning contract discussions, submitting a bid or proposal, or becoming aware of a business relationship with a local government officer. The Texas Ethics Commission provides this standardized form, which is designed to ensure transparency and ethical conduct in local government procurement processes.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CITY OF FORT WORTH - PURCHASING DIVISION
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
ITB Ref. #: 25-0156 Doc. Ref#: ITB-02 Page 1 of 3 ITB Title: Asphalt Hot and Cold Lay
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. Bylaw, 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/
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/
ITB Ref. #: 25-0156 Doc. Ref#: ITB-02 Page 2 of 3 ITB Title: Asphalt Hot and Cold Lay
ITB Ref. #: 25-0156 Doc. Ref#: ITB-02 Page 3 of 3 ITB Title: Asphalt Hot and Cold Lay
| ITB Title_2: |
| Text1: |
| Text2: |
| Text3: |
| Check Box4: Off |
| Text5: |
| Check Box6: Off |
| Check Box7: Off |
| Check Box8: Off |
| Check Box9: Off |
| Check Box10: Off |
| Text12: |
| Text13: |
| Text14: |
| Text16: |
File details come from the government source that posted it. Updated .