3-RFQt-02-CIQ Form (1).pdf

PDF 408 KB Posted

Attached to
RFQt Aluminum, Steel, Iron and Rebar
Solicitation number
25-0208
Issued by
Tarrant County, Texas

About this file

This document is a Conflict of Interest Questionnaire (CIQ) issued by the City of Fort Worth Purchasing Division for a Request for Quotation (RFQt) regarding Aluminum, Steel, Iron, & Rebar, with the reference number 25-0208. 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.

The CIQ form requires vendors to disclose any potential conflicts of interest, including employment or business relationships with local government officers or their family members. Vendors must file the questionnaire within seven days of beginning contract discussions or submitting a proposal, and must update the form if circumstances change. The form must be signed, and failure to comply can result in a Class C misdemeanor. The questionnaire covers various scenarios of potential conflicts, such as receiving taxable income from the local government entity or providing gifts to government officers, with specific guidelines for reporting these relationships.

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Text version

CITY OF FORT WORTH - PURCHASING DIVISION

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)

RFQt Ref. #: 25-0208 Doc. Ref#: RFQt-02 Page 1 of 3 RFQt Title: Aluminum, Steel, Iron, & Rebar

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. By law, 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/

RFQt Ref. #: 25-0208 Doc. Ref#: RFQt-02 Page 2 of 3

RFQt Ref. #: 25-0208 Doc. Ref#: RFQt-02 Page 3 of 3

File details come from the government source that posted it. Updated .