4-CIQ Forms-Updated 9-16.pdf

CONFLICT OF INTEREST QUESTIONNAIRE

All vendors doing business with Fort Bend Independent School (FBISD) must complete and submit a Conflict of Interest Questionnaire (CIQ).

FBISD is required to comply with Texas Local Government Code Chapter 176, Disclosure of Certain Relationships with Local Government Officers. Any company that does business with FBISD must complete and submit a Conflict of Interest Questionnaire (CIQ) whether or not a conflict of interest exists.

Statements must be filed within seven (7) business days after the officer becomes aware a conflict of interest exists.

Ms. Sonya Jones

Mr. Rick Garcia, Vice President

Mr. David Hamilton, Secretary

Dr. Marc Smith, Superintendent

Dr. Adam Stephens, Chief Academic Officer kimberly Smith, Chief Communications Officer

Bryan Guinn, Chief Financial Officer

Long Pham, Chief Information Officer Morgan

Aaron, Exec Dir Facilities

Schlacks Kelly, Exec Dir Finance

Amber Williams, Exec Dir HR

Jojo Jacob Exec Dir Info Systems

Christopher Nilsson, Exec Dir Info Tech Service

Dr. Andria Schur, Chief of Schools

Williams Stephanie, Exec Dir Org Development

Elizabeth Williams, Exec Dir Secondary Schools

Lyons-Lewis, Deidra Exec Dir Sec. Schools

Westbrook Pilar , Exec Dir Sel & Comp.Health

Lisa Langston Exec Dir Student Affairs

Hill Deena, Exec Dir Student Supp Svc

Hubbard Melissa, Exec Dir Teach & Learning

Richard Gay, Exec. Dir. Business Services

FBISD Board of Trustees include:

Ms. Kristin K. Tassin, President

Mr. Adam Schoof

Dr. Shirley Rose Gilliam

Ms. Angie Hanan

Current Local Government Officers includes:

Kathleen Brown, Deputy Superintendent

Dr. Jaretha Jordan, Deputy Superintendent

Beth Martinez, Deputy Superintendent

Coby Wilbanks, General Counsel

Glenda Johnson, Chief Human Resources Officer

David Rider, Chief of Police

Kwabena Mensah, Chief of Staff

Damian Viltz, Chief Operations Officer

Rhonda Mason , Asst Superintendent Elem

Dr. Stephen Warford, Asst Superintendent Sec

Antignolo Matthew, Exec Dir Child Nutrition

Pandit Payal, Exec Dir Collab Communities Daniel

Bankhead, Exec Dir D & Construction Nunez

Wendy, Exec Dir Elementary Schools Mason

Rhonda, Exec Dir Elementary Schools

Ford Ida, Exec Dir Elementary Schools

Jones Michael, Exec Dir Transportation

HOW TO COMPLETE THE CIQ FORM

NO CONFLICT EXIST

If no conflict of interest exists, you MUST:

1. Fill out Box 1

2. Type N/A on Box 3 of the CIQ form

3. Sign and date

CONFLICT EXIST

If a conflict of interest exists, you MUST:

1. Name of person doing business with the District. If the business is a corporation, partnership, etc., then each person who acts as an agent for the business in dealings with Fort Bend ISD must complete the form. Also, state company name. If no conflict of interest exists, you must fill out Box 1 and type N/A on Box 3 of the CIQ form, sign and date it.

2. Check the box if you are filing an update to a previously filed questionnaire. Updates are required by law by September 1 of each year in which the person submits a proposal or bid or begins contract discussions or negotiations with the District. Updates are also required by the 7th business day after an event that makes a statement in a previously filed questionnaire incomplete or inaccurate.

3. Name the District employee or school board member with whom you have a relationship, if there is no relationship in question, state “NONE”.

4. Answer questions A and B with “Yes” or “No”, as applicable.

5. Describe how you are affiliated or related to a FBISD employee or school board member.

6. Check Box if applicable

7. Signature Box: Date and Sign the form. A signature is required from the person completing the form even if “No” is entered in Box 3, A, B, C, or D.

Revised 1/1/2021Form provided by Texas Ethics Commission www.ethics.state.tx.us

For vendor doing business with local governmental entity

A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.

Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on:

(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity;

(B) a transaction conducted at a price and subject to terms available to the public; or

(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency.

Local Government Code § 176.003(a)(2)(A) and (B):

(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:

(2) the vendor:

(A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that

(i) a contract between the local governmental entity and vendor has been executed;

or

(ii) the local governmental entity is considering entering into a contract with the vendor;

(B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that:

(i) a contract between the local governmental entity and vendor has been executed; or

(ii) the local governmental entity is considering entering into a contract with the vendor.

Local Government Code § 176.006(a) and (a-1)

(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and:

(1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);

(2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or

(3) has a family relationship with a local government officer of that local governmental entity.

(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of:

(1) the date that the vendor:

(A) begins discussions or negotiations to enter into a contract with the local governmental entity; or

(B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or

(2) the date the vendor becomes aware:

(A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a);

(B) that the vendor has given one or more gifts described by Subsection (a); or

(C) of a family relationship with a local government officer.

For vendor doing business with local governmental entity

FORM CIQ

OFFICE USE ONLY

Date Received

This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor.

1 Name of vendor who has a business relationship with local governmental entity.

Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

3 Name of local government officer about whom the information is being disclosed.

Name of Officer

4 Describe each employment or other business relationship with the local government officer, or a family member of the officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer.

Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor?

Yes No

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity?

Yes No

5 Describe each employment or business relationship that the vendor named in Section 1 maintains with a corporation or other business entity with respect to which the local government officer serves as an officer or director, or holds an

Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

Signature of vendor doing business with the governmental entity Date ownership interest of one percent or more.

Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 1/1/2021