5-RFQt-02-CIQ Form.pdf
PDF 408 KB Posted
- Solicitation number
- 25-0235
- 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 Quotation (RFQt) with reference number 25-0235, titled "Bicycles, Parts, Accessories, Maintenance, and Repair". The CIQ is a legal requirement under Chapter 176 of the Local Government Code, mandating that any person or agent seeking to contract with a local governmental entity must disclose potential conflicts of interest.
The questionnaire requires vendors to provide detailed information about any business relationships with local government officers, including employment connections, potential financial transactions, and gift exchanges. Specifically, vendors must report any business relationships that could result in taxable income exceeding $2,500 in a 12-month period, or any gifts with an aggregate value over $100. The form must be filed within seven business days of beginning contract discussions or submitting a proposal, and vendors are advised to consult their own legal counsel to ensure compliance. Failure to properly complete and submit the form could result in a Class C misdemeanor.
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Text version
CITY OF FORT WORTH - PURCHASING DIVISION
CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
RFQt Ref. #: 25-0235 Doc. Ref#: RFQt-02 Page 1 of 3 RFQt Title: Bicycles, Parts, Accessories, Maintenance, and Repair
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. #: 25-0235 Doc. Ref#: RFQt-02 Page 2 of 3
RFQt Ref. #: 25-0235 Doc. Ref#: RFQt-02 Page 3 of 3
File details come from the government source that posted it. Updated .