3-RFP-02-CIQ Form.pdf
PDF 427 KB Posted
- Attached to
- RFP Customer Information System (CIS) Software
- Solicitation number
- 25-0128
- 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 Proposal (RFP) for Customer Information System (CIS) Software, with the RFP Reference Number 25-0128. The document outlines the legal requirements for vendors doing business with the local governmental entity, specifically detailing the mandatory disclosure of potential conflicts of interest pursuant to Chapter 176 of the Local Government Code. Vendors are required to file this questionnaire within seven days of beginning contract discussions or submitting a proposal, with the form needing to be completed and submitted to the City of Fort Worth Secretary.
The questionnaire requires vendors to disclose any business relationships that might cause a conflict of interest, including employment or business connections with local government officers or their family members. The form includes specific sections for reporting taxable income relationships, gifts, and other potential conflicts. Vendors must provide details about any employment or business relationships with local government entities, including whether they or their family members are receiving taxable income or have given gifts above a certain threshold. The document emphasizes that failure to properly disclose such information could result in a Class C misdemeanor, and compliance is the individual responsibility of each vendor or their representative.
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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 .