3-RFP-02-CIQ Form.pdf
PDF 430 KB Posted
- Attached to
- RFP Trenching and Shoring Equipment Rentals
- Solicitation number
- 25-0226
- 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 a Request for Proposals (RFP) with reference number 25-0226 for Shoring and Trenching Rentals. The document outlines the legal requirements under Chapter 176 of the Local Government Code for vendors doing business with the local governmental entity, specifically mandating that any person or agent seeking to contract with the City of Fort Worth must disclose potential conflicts of interest. The questionnaire must be filed with the City of Fort Worth Secretary no later than seven days after contract discussions begin or a proposal is submitted.
The form requires vendors to provide detailed information about any business relationships that might cause a conflict of interest, including employment or business connections with local government officers or their family members. Vendors must disclose if they or their family members are receiving taxable income from the local government entity, have gifts exceeding $100 in a 12-month period, or maintain a business relationship with a corporation where a local government officer serves as an officer or director. The document emphasizes that compliance is the individual responsibility of each person or agent, and failure to properly disclose potential conflicts can result in a Class C misdemeanor.
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
RFP - CIQ RFP Ref. #: 25- Page 1 of 3
RFP Title:_________________________________________________________
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/
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.
https://www.ethics.state.tx.us/forms/conflict/
RFP - CIQ RFP Ref. #: 25- Page 2 of 3
RFP Title:_________________________________________________________
RFP - CIQ RFP Ref. #: 25- Page 3 of 3
RFP Title:_________________________________________________________
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File details come from the government source that posted it. Updated .