9-CIQ Forms-Updated 8.14.25.pdf

PDF 318 KB Posted

Attached to
Stop Loss Insurance
Solicitation number
RFP 26-023KB
Issued by
Fort Bend County, Texas

About this file

This document is a Conflict of Interest Questionnaire (CIQ) for vendors doing business with Fort Bend Independent School District (FBISD) in Texas. The document details the requirements for vendors to complete and submit the CIQ in compliance with Texas Local Government Code Chapter 176, which mandates disclosure of certain relationships with local government officers. Vendors must file the questionnaire within seven business days of becoming aware of any potential conflicts, whether or not an actual conflict exists. The document provides a comprehensive list of FBISD Board of Trustees and Current Local Government Officers, including the Superintendent, Deputy Superintendents, and various executive directors.

The CIQ form requires vendors to disclose any employment or business relationships with local government officers or their family members, including potential taxable income exceeding $2,500 in a 12-month period or gifts with an aggregate value of more than $100. Vendors must provide details about any such relationships, answer specific questions about potential financial connections, and sign the form. The document emphasizes that failing to properly complete and submit the questionnaire can result in a misdemeanor offense. The form is designed to ensure transparency and prevent potential conflicts of interest in business dealings between vendors and the school district.

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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 a conflict of interest exists.

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

FBISD Board of Trustees Include:

Kristin K. Tassin, President

Angie Hanan, Vice President

Dr. Shirley Rose Gilliam, Secretary

Adam Schoof

Afshi Charania

Angie Wierzbicki

Current Local Government Officers Include:

Dr. Marc Smith, Superintendent

Kathleen Brown, Deputy Superintendent

Dr. Jaretha Jordan, Deputy Superintendent

Beth Martinez, Deputy Superintendent

Chassidy Olainu-Alade, Chief Comm. Officer

Bryan Guinn, Chief Financial Officer

Stephanie Williams, Chief of Organizational Dev.

Dr. Adam Stephens, Chief Academic Officer

Glenda Johnson, Chief Human Resources Officer

Long Pham, Chief Information Officer

Dr. Andria Schur, Chief of Schools

Derrick Ward, General Counsel

Anthony Sanders, Chief of Police

Siomara Saenz-Phillips, Asst. Superintendent Elem

Dr. Stephen Warford, Asst. Superintendent Sec.

Framy Diaz, Exec. Dir. Elementary Schools

Ida Ford, Exec. Dir. Elementary Schools

Wendy Nunez, Exec. Dir. Elementary Schools

Dr. Alfred James, Exec. Dir. Secondary Schools

Elizabeth Williams, Exec. Dir. Secondary Schools

Matthew Antignolo, Exec. Dir. Child Nutrition

Pandit Payal, Exec. Dir. Collab Communities

Jasmin Russell, Exec. Dir Org. Development

Pilar Westbrook, Exec. Dir. Sel. & Comp. Health

Daniel Bankhead, Exec. Dir. Des. & Construction

Christopher Nilsson, Exec. Dir. Info Tech Service

Jojo Jacob, Exec. Dir. Info Systems

Aaron Morgan, Exec. Dir. Facilities

Richard Gay, Exec. Dir. Business Services

Melissa Hubbard, Exec. Dir. Teach & Learning

Kelly Schlacks, Exec. Dir. Finance

Amber Williams, Exec. Dir. HR

Lisa Langston Exec. Dir. Student Affairs

Dahria Driskell, Exec. Dir. Student Supp Svc.

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

RFQuote 23-089KB Required Forms
Required Forms
Required Forms (5)
CIQ Form 101622
CIQ Instructions
CIQ 1-21 Form
OFFICE USE ONLY:
Date Received:
Check this box if you are filing an update to a previously filed questionnaire The law requires that you file an updated:
Name of Officer:
Yes:
No:
Yes_2:
No_2:
undefined:
Date:
Signature1_es_:signer:signature:
Text2:
Text3:
Text4:

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