Text Box: FORM CIQ

 

 


CONFLICT OF INTEREST QUESTIONNAIRE

 

For vendor or other person doing business with local governmental entity

 

This questionnaire is being filed in accordance with chapter 176 of the Local Government Code by a person doing business with the governmental entity.

By law this questionnaire must be filed with the records administrator of the local government not later than the 7th business day after the date the person becomes aware of facts that require the statement to be filed. See Section 176.006, Local Government Code.

A person commits an offense if the person violates Section 176.006, Local Government Code. An offense under this section is a Class C misdemeanor.

 

Text Box: Office Use Only

 

 

 

 

Date Received

Text Box: 1

 

         Name of person doing business with local governmental entity.

 

 Center for Equity and Adequacy in Public School Finance Inc.

 

 

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                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 September 1 of the year for which an activity described in Section 176.006(a), Local Government

                        Code, is pending and not later than the 7th business day after the date the originally filed questionnaire

                        becomes incomplete or inaccurate.)

 

 

Text Box: 3

 

           Describe each affiliation or business relationship with an employee or contractor of the local governmental

           entity who makes recommendations to a local government officer of the local governmental entity with

           respect to expenditure of money.

  

 

 

None

 

 

 

 

 

 

 

 

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Text Box: 5
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            Describe each affiliation or business relationship with a person who is a local government officer and who

            appoints or  employs a local government officer of the local governmental entity that is the subject of this

            questionnaire.

 

 

None

 

 

 

 

 

 

 


 

Text Box: FORM CIQ
Page 2

 

 


CONFLICT OF INTEREST QUESTIONNAIRE

 

For vendor or other person doing business with local governmental entity

 

 

          

 

         Name of local government officer with whom filer has affiliation or business relationship. (Complete this

        section only if  The answer to A, B, or C is YES.)

       
       
This section, item 5 including subparts A, B, C & D, must be completed for each officer with whom the filer has

           affiliation or business relationship. Attach additional pages to this Form CIQ as necessary.

 

A.       Is the local government officer named in this section receiving or likely to receive taxable income from the filer of the

        questionnaire?

                                            

                                            Yes            X            No

 

 

B.       Is the filer of the questionnaire receiving or likely to receive taxable income from or at the direction of the local

        government  officer named in this section AND the taxable income is not from the local governmental entity

                                            Yes             X           No

 

 

C.      Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government

        officer serve as an officer or director, or holds an ownership of 10 percent or more?

 

                                            Yes              X          No

 

 

          D. Describe each affiliation or business relationship.

 

 

 

 

 

          Describe any other affiliation or business relationship that might cause a conflict of interest.

 

 

 

 

 

 

                                                                                                                          

 

Text Box: 7

 

   

                   Wayne Pierce, Executive Director

                   Center for Equity and Adequacy in Public School Finance Inc .

                                                                                                                                                                        February 9. 2006
            Date

                           Signature or person doing business with the governmental entity