6-5. Conflict of Interest Form.pdf

PDF 1 MB Posted

Attached to
Request for Qualifications for 2026 Sanitary Sewer Basin Evaluation
Solicitation number
26-0216
Issued by
Tarrant County, Austin City, Texas

About this file

Conflict of Interest Questionnaire for City of Arlington Sanitary Sewer Basin Evaluation RFQ

This document is a Conflict of Interest Questionnaire (CIQ) form issued by the City of Arlington, Texas, Office of Procurement in accordance with Chapter 176 of the Local Government Code. The form is required for any person or agent seeking to contract or bid for the sale or purchase of property, goods, or services with the City of Arlington. The questionnaire establishes a standardized process for disclosing any affiliations or business relationships that might create conflicts of interest with the local governmental entity. Vendors must complete the form regardless of whether they have identified conflicts; those without known conflicts must state the proposer name in Section 1 and mark "N/A" in the remaining areas, though a signature is mandatory in Section 7 in all cases.

The CIQ form requires disclosure of the vendor name, names of any officers, and detailed descriptions of employment or business relationships maintained between the vendor and any corporation or business entity in which a local government officer serves as an officer, director, or holds an ownership interest of one percent or more. Updated questionnaires must be filed in accordance with Chapter 176 requirements. The form is available through the Texas Ethics Commission at https://www.ethics.state.tx.us/forms/conflict/ and must be submitted with bid or proposal documents as a condition of participation in the City of Arlington procurement process for the 2026 Sanitary Sewer Basin Evaluation engineering services contract.

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CITY OF ARLINGTON - OFFICE OF PROCUREMENT

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)

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 Arlington) 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. 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/

Project Number: Page 2 of 3 Project Title:

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
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 ca...
Project Title:
lJ Nlame ot vendor who has b11siness retatianshipwiU1 locrl govemmemal Qnlity:
Name oi Officer:
w Describe each employment or busi11ess 1Nlaticmshp th 1 the VQndor 1named in Section 1 mai11tai11s wilh a corporation or o1her business Qn1i1y wi1h respect to wihich 1he local govemment officer serves as 11 offioer or directo or holds 11n ownership interest of ooo pefcent or more:
Text1:
Text2:
Text3:
Text4:
Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off

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