4-ITB-02-CIQ Form.pdf
PDF 1 MB Posted
- Attached to
- ITB Oral Rehydration Packages
- Solicitation number
- 25-0223
- Issued by
- Tarrant County, Texas
About this file
This document is a Conflict of Interest Questionnaire (CIQ) issued by the City of Fort Worth's Purchasing Division for an Invitation to Bid (ITB) with reference number 25-0223, specifically for Oral Rehydration Packages. The CIQ is a mandatory form pursuant to Chapter 176 of the Local Government Code, which requires any person or agent seeking to contract with a local governmental entity to disclose potential conflicts of interest. The form must be filed with the City of Fort Worth Secretary no later than seven days after beginning contract discussions, negotiations, or submitting a bid response.
The questionnaire requires vendors to provide detailed information about their business relationships with local government entities, including any employment or financial connections that might create a potential conflict of interest. Specifically, vendors must disclose if they or their family members have received taxable income exceeding $2,500 from the local government entity in the preceding 12-month period, or if they have given gifts to local government officers. The form emphasizes transparency and requires vendors to update the questionnaire if their circumstances change, with potential legal consequences for failing to accurately complete the document.
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
ITB Ref. #: 25- 0223 Doc. Ref#: ITB-02 Page 1 of 3 ITB Title: Oral Rehydration Packages
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- 0223 Doc. Ref#: ITB-02 Page 2 of 3 ITB Title: Oral Rehydration Packages
ITB Ref. #: 25- 0223 Doc. Ref#: ITB-02 Page 3 of 3 ITB Title: Oral Rehydration Packages
File details come from the government source that posted it. Updated .