4-RFQt-02-CIQ Form.pdf
PDF 416 KB Posted
- Attached to
- RFQt Weapons Retrofitting
- Solicitation number
- 25-0215
- Issued by
- Tarrant County, Texas
About this file
The document is a Conflict of Interest Questionnaire (CIQ) issued by the City of Fort Worth Purchasing Division for a Weapons Retrofitting request for quotation (RFQt) with reference number 25-0215. 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 the person begins contract discussions or submits a proposal, and it applies to any business relationship that might cause a conflict of interest.
The questionnaire is designed to capture detailed information about potential conflicts, including employment or business relationships with local government officers, taxable income connections, and gift disclosures. Vendors must complete the form even if they are not aware of any conflicts, in which case they should use "N/A" in the sections and provide a signature. The form follows specific legal requirements outlined in the Local Government Code, with potential consequences for non-compliance, including the classification of failure to file as a Class C misdemeanor. The document provides a link to the Texas Ethics Commission website for additional guidance and emphasizes that compliance is the individual responsibility of each person or agent subject to the filing requirement.
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
RFQt Ref. #: 25-0215 Doc. Ref#: RFQt-02 Page 1 of 3 RFQt Title: Weapons Retrofitting
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. #: 25-0215 Doc. Ref#: RFQt-02 Page 2 of 3
RFQt Ref. #: 25-0215 Doc. Ref#: RFQt-02 Page 3 of 3
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File details come from the government source that posted it. Updated .