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HomeMy WebLinkAboutConflicts Disclosure Statement-Conflict of Interest-12/1/2016 (2)LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. OFFICE USE ONLY Date CITY Received AUG SECRETARY'S --- 0 2016 OFFI 1 Name of Local Government Officer City Manager's Office 2 Office Held 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Atmos Energy 4 Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. Local Gas Company 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted 8/9/16 Description of Gift Mini Cupcakes - 12 Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement 5-01I.9LtZl #Ql keioN 304, � . 61/Z0/Z l .dx3 •wwo0 Itw Ait :i Mei io eieiS 1/ fueioN oa overs the 12-month period described j bSection 176.003(a)(2)(B), Local Government Code. t1 ollQnd fa"' .... . _ .. AFFIX NOTARY STAMP / SEAL ABOVE Sworn before by the said Signa J "aflc ( E'wsl A ure \.l f Local Government Officer , this the IO day to and subscribed me, ' US4- , 20 de , to certify which, witness my hand and seal of office. f 411 1 1 «( Ka! icit Sign: t e of officer administering oath Printed a e of officer inistering oath Title of officer administer'n oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. _,. o _ VIE"" ,1 Name of Local Government Officer Jody Short CITY OCT 9 8 2016 54.5 a M. SECRETARY'S OFFICE 111 2 Office Held Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Teague Nall and Perkins 4 I Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in Item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Enginggsing has performed work, unrelated to Colleyville, for Teague Nall and Perkins within the past Months and Teague Nall and Perkins has a current contract with Colleyville. 51 List gifts accepted by the local government officer and any family member, If aggregate value ofthe glfts accepted from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12-month period described by Section 176.00 (a)(2)(B),/ Local Government Code. o�pP......, l�9 Katherinemi s on x 4g I, 0My8 Commission Expires - //• r9�\.. 0813012020 ../e -freaky ID No. 130723546 AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said SJV(��t(�/7 I- Y ( J Signature of Local Government Officer Y \Vrtthis the 11 day of October20 16 to certify which, witness my hand and seal of office. (kiltiCALvJ Mitrilnt VJ NON R is Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 841h Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. 1 a Name of Local Government Officer Jody Short _ CITY OCT zoic SECRETARY'S OFFICE 2 Office Held Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Bridgefarmer & Associates, Inc. 4 I the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville; for Bridgefarmer & Associates, Inc. within past 12 Months. Bridgefarmer & Associates, Inc. may or may not have a current contract with Colleyville. J List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12-month period described by Section 16.003(a)(2)(B), Local Government Code. / Katherine Wright l • 06 Commission Expires ✓✓� uy;�.j' ID No.. i30 /F�6ir� ID No. 130723546 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE P'yn/1y,,� 1y� Sworn to and subscribed before me, by the saidlObt�r i ` c' `Off- this the 27 day of October 20 16 to certify which, witness my hand and seal of office. Otn-er( WI/W. Nctatki P o Uc* Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code.o - 1 Name of Local Government Officer Jody short I OCT `flf5/tb-t 2 8 2016 _. 2 Office Held <ITY SECRETARY'S OFFICE, Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code TranSystems Corporation Consultants q I I but Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named In item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, Lee Engineering has performed work, unrelated to Colleyville, for TranSystems Corporation Consultants within the past 12 Months. TranSystems Corporation Consultants has a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named. In Item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted Na Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) J AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12-month period described by Section 176 103(a)( (B), Local Government Code. Put Kathedne Wright s�.r , MyCommission Expires jm 06/30/2020 // 'A. ID No. 130723646 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE < Sworn to and subscribed before me, by the said �Xp/1'p/�1 V\ J Y S ` this the 21 day of October16 20 to certify which, witness my hand and seal of office. (60\7 c Uftir— to,Ae W4(10-- Nb- ,v 10di211 L Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. Date Received tii . 1 Name of Local Government Officer Jody Short � ,....0 OCT L 2 8 VE 2016 mg III Office Held 3 `3ITY SECRETARY'S FICEs Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Freese & Nichols, Inc. 4 I Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Freese and Nichols, Inc. within the past 12 months and Freese and Nichols, Inc. has a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a' Description of Gift n/a Date Gift Accepted Description of. Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer, I also acknowledge that this statement vro covers the 12 -month period described by Section 176.003(a)(2)(B), Local Government Code. c_.-, Katherine Wright gg , My Commission Expires ugjf 0613012020 ID No. 130723546 ( Noy', Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE "ciSworn to and subscribed before me, by the said T N.R� ' l yr w4 this the 2.1 day of October 20 16 to certify which, witnessitmy hand and seal of office. UM V v`-' VVl/dc (GO t ik, WILNbttA;N Pv01,(C- X. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law. by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code. 11 /7 v EIll 1 Name of Local Government Officer Jody Short n OCT 2 0 7016 I .415 ;ITY SECRETARY'S 2 Office Held t OFFICE r Member of Colleyville City Council, Place 4 il Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Kimley-Horn 4 I Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in Item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Kimley-Horn within the past 12 months and Kimley-Horn has a current contract with Colleyville. J LIst gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(S). Date Gift Accepted n/a Description of Gift n/a Date Gift 'Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT 1 swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement overs the 12 -month period described by Section 176 ^ 03(a)( (B), Local Government Code. 049P4 Katherine Wright ?j�pry, , My Commission Expires ,. je 0613012020 if ppt ID No. 130723546 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE (J y�/1t1 \ //� Sworn to and subscribed before me, by the said se,0A 1 \ I } this the (/-) day of October 20 16 , to certify which, witness my hand and seal of office. lit aA t'cc % 00111.`e- 1N1r1 Mo ✓ i P&- T?C Signature of officer administering oath Printed name of officer administering oath Tide of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code. H• VI 1 Name of Local Government Officer Body snort To OCT q1Lt5 2 8 2016 1 J Office Held ,JITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Halff Associates 4 Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named In Item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Halff Associates within the past 12 months and Halff Associates has a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in Item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted riteDescription of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) J AFFIDAVIT 1 swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12-month period described by Section 176.0a)(2)(B)) Local Government Code. (*)Katene wy omissires 0810020 ID No. 130723546 - Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE rr^^[[p((�I/t/t (}� Sworn to and subscribed before me, by the said -S�./C e4 1 v f w' 1. this the 11/1 day of October20 16 , to certify which, witness my hand and seal of office. 2 ►(lk PAintVIN, writ -No NK OO Signature of officer administering th Printed name of officer aaminist nng oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. Date Received n 1 Name of Local Government Officer Jody Short 3 e OCT rr 28 al q5AtiA4 V E,v� 2M13 2 Office Held `CITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code ANA Consultants 4 I Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named In. item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for ANA Consultants within the past 5 years and ANA Consultants may or may not have a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named In item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement .covers the 12 -month period described by Section 176. 3(a)(2) B), Local Government Code. ft Katharine Wright(((( '9�\�ir 0613012020 ,( �, My 0630/202 Commission Expires `� V. ID No. 130723546 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE(lam n --(��f'� this the I1 day Sworn to and subscribed before me, by the said , S "SR ( t of October20 16 to certify which, witness my hand and seal of office. 7 ► f - Vit,t6Leinft Wri kr N gorN1)blic Signature of officer administering th Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. Date Received 1 Name of Local Government Officer Jody Short e OCT lav C n B \\.// E l/ 2 8 2036 2 Office Held g.'tf 5 41'v% CITY SECRETARY'S OFFICE, Member of Colleyville City Council, Place 4 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Baird, Hampton & Brown, Inc. 4 the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. -- am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Baird, Hampton & Brown, Inc. within past 12 Months and Baird, Hampton & Brown, Inc. may or may not have a current contract with Colleyvi!IE List gifts accepted by the local government officer and any family member, If aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a. Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT .:I s4{ I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Govemment Code) of this local government officer. I also acknowledge that this statement covers the 12-month period described, by Section 176. t' (a)(2) :), Local Government Code. N Kathednewright My Commission Expires j/7 ignature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE Ql'(,�.I1',�, /l``y,,1 / t Sworn to and subscribed before me, by the said ��v' ' "' "01 this the 21 day of October 20 16 to certify which, witness my hand and seal of office. 14 eAkti ' /t°t ///t/j/p J{t'' t Whir e Wr 0 iJoktILN Pu i & TC Signature of officer administering oath Printed name et officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. Cate Received a 1 Name of Local Government Officer lody Short , OCT .,,D ,., 9 8 v rE 0 2016 2 Office Held CITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Brockette-Davis-Drake Inc 4 I I but the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in Item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, Lee Engineering has performed work, unrelated to Colleyville, for Brockette-Davis-Drake Inc within past 12 Months and Brockette-Davis-Drake Inc may or may not have a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, If aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 1 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12 -month period described by Section 1 6.003(. (2)(B), Local Government Code. Opvv Katherine. Wright ^ * My Commission Expires 3 . 06130/2020 lit" --W ID No. 130723546 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE �(�/,�I/� SVA ! y1.. Sworn to and subscribed before me, by the said , YJ ji' •' 5r ,O/ ` this the 2:1 day of October 20 16 , to certify which, witness my hand and seal of office. , (}5Al2/14k-41¥W n8rInt \ It4 Motel `kbit -QC, Signature of officer administer g oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www. eth ics.state.tx. us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) Thisquestionnaire reflects changes made to the law. by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code. l^ n 1 Name of Local Government Officer Jody Short •• 1 a E OCT E_ W 2 8 2016 111 2 Office Held i ITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Burgess & Niple 4 I but the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, Lee Engineering has performed work, unrelated to Colleyville, for Burgess & Niple within past 12 Months and Burgess & Niple may or may not have a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 5 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12 -month period described by Section 17 .003(a) )(B), Local Government Code. Katherine Wright ', 3om0ission Expires 06 ' / jQ 0613012020 // 4'4 ID No. 130723546 4'4" Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE p�Q Sworn to and subscribed before me, by the said �"�f�'lJt- S -1- this the 2.1 day of October 20 16 to certify which, witness my hand and seal of office. Oktillit4 `\jU/p Gt ` 'int V\\rUInt �tOr klic. C ath Signature of officer administering .Printed name of officer adriiinistering oath Title of officer administering oath Form provided by Texas Ethics Commission www.eth ics.s tate.tx. us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. Date Received 1 Name of Local Government Officer Jody Short T - �//p '—_ �.....n1_ l/ OCT 2 8 2016 2 I Office Held `C Member of Colleyville City Council, Place 4 r 45 TY SECRETARY'S OFFICE 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Huitt-Zollars, Inc. 4 I the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Huitt-Zollars, Inc. within past 12 Months. Huitt-Zollars, Inc. may or may not have a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, If aggregate value ofthe gifts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement yyA covers the 12 -month period described by Section 17. 003(a; 2)(B), Local Government Code. My Commission Ex �lNr� „ 06 Commission Expires /J st" OBIN0/2020 o.130 (/ ppt� ID,No. 130723548 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE ���(�/y� I`(�I /u���n f],� Sworn to and subscribed before me, by the said v"' er(n t 'r "rt U, " this the 27 day of Octo�/)1/b�e�r//�� . 20 16 to certify which,hichwitness hand seal of office. � 1 (mypland Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11)30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) ThIs questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code. —ll _ U �\t\/n/ 11 Name of Local Government Officer Jody Short — --° ' OCT i LS ? 8 V 2016 Alt/ -- Im In 2 Office Held tf ITY SECRETARYOFFICE . Member of Colleyville City Council, Place 4 11 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government. Code. Wier & Associates, Inc. 4 I the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in Item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Wier & Associates, Inc. within past 12 Months. Wier & Associates, Inc. may or may not have a current contract with Colleyville. J List gifts accepted by the local government officer and any family member, If aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT 1 swear under penalty of perjury that the above statement is true and correct. 1 acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. 1 also acknowledge that this statement covers the 12-month period described by Section 176.003(a) 2)(B), Local Government Code. kr- l Kathedne Wdght j My 130/20 Commission Expires /� 0613012020 // vFai ID No. 130723546 ail AFFIX NOTARY STAMP / SEAL ABOVE �1 iy^1'/y1,� Sworn to and subscribed before me, by the said `�"V' ,nt 01('" Signature of Local Government Officer '//1 this the `1 day of October 20 16 to certify which, witness my hand and seal of office. /Yak jia (tAil \(aVIl`S`Yh t IN tne &,o vat NIL Th Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.lx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in Chapter 176, Local Government Code. Date Received accordance with ��% 1 Name of Local Government Officer Jody Short - ,_ OCT _,.o 8' `(i5A-raj' _ 9 8 V 2916 LU Office Held ;ITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Birkhoff, Hendricks & Carter 4 I the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in Item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Birkhoff, Hendricks & Carter within past 12 Months. Birkhoff, Hendricks & Carter may or may not have a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in Item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers, the 12 -month period described by Section 17 003( (2)(B), Local Government Code. AApCf.MyCo Katherine Wright �, MY Commission Expires /r .. 06/30/2020 ?or. ID No. 130723546 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said-ICC/Pk v' ""this the day 717 of October20 16 , to certify which, witness my hand and seal of office. TIOThivut4AlAteflar WI lOcrtaN f 1 c it. Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www, eth ics.state .tx. us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code.ea't‘RIM JName of Local Government Officer Jody Short - E OCT 87) �rr� D- y 8 inAttI - 1✓ 20Th LL 2 office Held CITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code BSP Engineers, Inc 4 I the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for BSP Engineers, Inc within past 12 Months. BSP Engineers, Inc may or may not have a current contract with Colleyville. 51 List gifts accepted by the local government officer and any family member, If aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. 1 acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12 -month period described by Section 176.0 r3(a)(. )(B), Local Government Code. at PKatherine Wright My Commission Expires ft ,4 06/30/2020 •i yApF* ID No. 130723546 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE \ (p`n. (t Sworn to and subscribed before me, by the said U©J 1 A✓ �, °O�� this the ( 11 day of October 20 16 to certify which, witness my hand and seal of office. (MCCiP7V c 4Pv/\erin ew,iwt Nokia{, R IAtc- K Signature of officer administering oath .Printed name of officer administering oath Title of officer administering oath. Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. Date Received p Name of Local Government Officer Jody Short E...o OCT S! i V E irliJ 2 8 203& 'h-! Illi 2 Office Held `f ITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 I Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code BW2 Engineers 4 I Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in. item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for BW2 Engineers within 12 Months. BW2 Engineers may or may not have a current contract with Colleyville. IIpast II List gifts accepted by the local government officer and any family member, If aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) -61 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12 -month period described by Section 1 '6.003 =)(2)(B), Local Government Code. Katherine Wright \\` .i My Commission Expires �( 20 '78b IV- D No. 130723546 - ' AFFIX NOTARY STAMP / SEAL ABOVE T (p�/;�� Sworn to and subscribed before me, by the said UOJI/Y Stp` r l S Signature of Local Government Officer `o(1 this the Ti day of October 20 16 to certify which, witness my hand and seal of office. 2ila d VakcntriKC Wr l(\fFO-061 Pdbt- l)C Signature of officer administering oath Printed name of officer admi istering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code. �r 1. `\` T 1 Name of Local Government Officer Jody Short `� OCT - 2 8 /� U iL 20016 � J office Held CITY SECRETARY'S OFFICE) Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Childress Engineering 4 I but the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named In Item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, Lee Engineering has performed work, unrelated to Colleyville, for Childress Engineering within past 12 Months. Childress Engineering may or may not have a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in Item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) —61 AFFIDAVIT 1 swear under penalty of perjury that the above statement is true and correct. 1 acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement Katherine Wright ' it covers the 12-month period described by Section 6.0ggq333(a)(2)(B), Local Government Code. YV)S,° 06 30/2020 on Expires ... i ID No, 130723546 ID No, 130 7 �FoF( AFFIX NOTARY STAMP / SEAL ABOVE f Sworn to and subscribed before me, by the said 3t6t�)(,p Signature of Local Government Officer 51100—g"� this the 21day off/%/October 20 116//]�� to certify which, witness�it(�tm�y{hhannd and of office. ,/t,(./ �1,seal e f�- i' ] (y/�, / `/ Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. Date Received �% 1 Name of Local Government Officer Jody Short E OCT ...n E 28 V 2016 EB 2 Office Held ITY SE RET RY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code J. Volk Consulting 4 I the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for J. Volk Consulting within past 12 Months. J. Volk Consulting may or may not have a current contract with Colleyville. 51 List gifts accepted by the local government officer and any family member, If aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local govemment officer. I also acknowledge that this statement pv�� covers the 12-month period described by Section 176.00 a)(2)(B), Local Government Code. o . Katherine Wright , My Commission Expires %v 06/30/2020 / ID No.130723546 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE P� (\}{'�\ Sworn to and. subscribed before me, by the said t0SCI "' '6it this the 11 day of October20 16 to certify which, witness my hand and seal of office. iia ditAil--- `Iak%\SruS.e W r N&k W9 Rbc uc;1 Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.elh ics.state.tx. us Revised 11/30/2015 Form provided by Texas Ethics Commission www.eth ics.state.tx. us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. OFFICE USE ONLY Date Received 1 1 Name of Local Government Officer Jody Short 1 (� LIL- 1 LE C LE ij V OCT 2 8 2016 Office Held Member of Colleyville City Council, Place 4 g,'45. ITY,SECRETARY'S OFFICE so 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Jacobs Engineering Group 4 Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. I am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Jacobs Engineering Group within the past 12 Months. Jacobs Engineering Group may or may not have a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, If aggregate value of the gifts accepted from vendor namedin item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is that the disclosure applies to each family member (as defined Government Code) of this local government officer. I also covers the 12 -month period described, by Section 17 003(a)( *v�r& Katherine Wright 7 My Commission Expires lc 06130/2020 true and correct. I acknowledge by Section 176.001(2), Local acknowledge that this statement )(B), Local Government Code. jiefiV- ID No. 1301235403 Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said ll",t��h Choi this the InTr`�/� day of October 20 16 to certify which, witness my hand and seal of office. Notal t PDI*C VC G/.D/�/ V% «U h'erlu\t V,/ h11- Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath. Form provided by Texas Ethics Commission www.eth ics.state.tx. us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code. �'� —nI IJ LL 1 Name of Local Government Officer Jody Short OCT "M 2 82016 ys 2 Office Held '. Held CITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Jerry Parche Consulting Engineers 4 I the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Jerry Parche Consulting Engineerswithi past 12 Months.Jerry Parche Consulting Engineers may or may not have a current contract with Colleyvill 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) –61 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement yp covers the 12-month period described by Section 176.003(a) )(B), Local Government Code. ma... ec Katherine Wright I, My Commission Expires . ,4 06/30/2020 1'60 ID No. 130723546- ' Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE �j(p (�/1 /\- /� Sworn to and subscribed before me, by the said 1"u ter `' 1 Sh0A this the 71--7 day of October 20 16 to certify which, witness my hand and seal of office. e W M &u €- Wrt/�] AM-12R aNbltc 1K Signature of officer administering oath Printed name of officer adminiS4ering oath Title of officer administering oath Form provided by Texas Ethics Commission www. eth i cs. state.tx. u s Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire This is the government in accordance reflects changes made to the law by H.B. 23, 84th Leg., .Regular Session. OFFICE USE ONLY notice to the appropriate local governmental entity that the following local officer has become aware of facts that require the officer to file this statement with Chapter 176, Local Government Code. Date Received Name of Local Government Officer Jody Short j LE LE Ll__ LI W OCCT`/2 821,016 O., `r5/T/"7 CITY SECRETARY'S OFFICE ` Office Held Member of Colleyville City Council, Place 4 3 ( Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code mycoskie+mcinnis+associates 4 Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. I am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for mycoskie+mcinnis+associates within past 12 Months. mycoskie+mcinnis+associates may or may not have a current contract with Colleyville. CtIhe J List gifts from vendor Date Date Gift Date Gift accepted by the local government officer and any family member, If aggregate value of the gifts accepted named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Gift Accepted n/a.. Description of Gift h/a Accepted Description of Gift Accepted Description of Gift (attach additional forms as necessary) AFFIDAVIT d�T '(;/,.. �oF� AFFIX Sworn to of October I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12-month period described by Section 17r03(a)( )(B), Local Government Code. ht Katherine Commission Expires � �, My Commission Expkee / _ 1/- ID No. 130 ID No. 130723546 - Signature of Local Government Officer NOTARY STAMP / SEAL ABOVEhelbiSr- /�\"' C/'pr�yy,,�`\ and subscribed before me, by the said S6J1/r ' ' this the :-.1 day 20 16 to certify which, witness my hand and seal of office. P4iiIr✓U 9 aA.OA ✓ A)Mic 4A\kte <iNi W I t NtAaAt Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. OFFICE USE ONLY Date Received OCT SECRETARY'S 28 2016 OFFICE 1 Name of Local Government Officer Jody Short 2 Office Held v Member of Colleyville City Council, Place 4 ITY JName of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code RPGA Design Group 4 I Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named In Item 3. I am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for RPGA Design Group within the past 12 Months. RPGA Design Group may or may not have a current contract with Colleyville. J List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in Item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) AFFIDAVIT tax pr,' %. Kathedne Wright ft i„+ My Commission Expires /c 06130/2020 14.'49 ID No.130723546/// AFFIX NOTARY STAMP / SEAL Sworn to and subscribed before me, of October20 16 I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement - covers the 12 -month period described by Section 176 03(a)( (B), Local Government Code. Signature of Local Government ABOVE �`yq�/� C�/� by the said �O�ln” r I ✓ 1 6OV this officer Officer /.1/��'/7 the L .day to certify which, witness my hand and seal of office. :Ai ering (\n-cv‘i'Jb0IG oath Title of TiC administering oath 916 AA) SOWi� Wrt Signature of officer administering oath Printed name of officer admin Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code.__ jj" 1 Name of Local Government Officer Jody Short OCT o v 2 8 2016 RR/5W 2 Office Held CITY SECRETARY'S OFFICE Member of Colleyville City Council, Place 4 3 Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Winkelmann & Associates 4 I the Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named In Item 3. am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Winkelmann & Associates within past 12 Months. Winkelmann & Associates may or may not have a current contract with Colleyville. 5 List gifts accepted by the local government officer and any family member, if aggregate value ofthe gifts accepted from vendor named In Item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) 6 AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement covers the 12-month period described by Section 176.003;:) )(B) ocal Government Code. "IN Katherine Wright / 7 �I. 0My 830/202sfon Expires rc 0613012020 (P. �9'a nFa ID No. 130723546 AFFIX NOTARY STAMP / SEAL ABOVE (%oj� Sworn to and subscribed before me, by the said5Jvl I i S Signature of Local Government Officer �/� y1- n/ lo(1 this the 2 1 day of October20 1T to certify which, witness my hand and seal of office. CIDn14/ (evert WM(//(yp�Ji'' N 1-a RbtLCC, Signature of officer administenng oath Printed name of officer ad inr7 istering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received in accordance with Chapter 176, Local Government Code. v F E fry rrp� 1 Name of Local Government Officer Jody Short OCT 020,91 ti- 0 1 vM tf� 2016 2 Office Held CITY SECRETARY'S OFFIC Member of Colleyville City Council, Place 4 JName of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code Graham JDescription of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. I am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work, unrelated to Colleyville, for Graham within the past 12 months and Graham may or may not have a current contract with Colleyville. J List gifts accepted by the local government officer and any family member, if aggregate value of the glfts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted n/a Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement overs the 12 -month period described by Section 176.003(a)(2)(15 Local Government Code. Kattredne wdght slon E> ms // e l�-IN7 i 06/30/2020 tk, 6 30/202 '�<.,,...,. V ID No. 130 - �oF ID No. 130723546 /// Signature of Local/Government Officer AFFIX NOTARY STAMP / SEAL ABOVE �r` Q�()r/} Sworn to and subscribed before me, by the said cN '^ '- this the \ day of November 20 16 to certify which, witness my hand and seal of office. 7116VKQvv ^I 1 '� Xl�he Or �(, Pubu,c. ` ketaSc Signature of officer admmi`innisteriNg oath Printed name of officer ad istering oath Title of officer administering oath Form provided by Texas Ethics Commission www.ethics.state.tx. us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on,the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement in accordance with Chapter 176, Local Government Code. OFFICE USE ONLY Date 9eCpived OCT 0 12016 CITY SECRETWRY'S OFFICI JName of Local Government Officer Jody Short7/�� ] Office Held Member of Colleyville City Council, Place 4 JName of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code CP&Y, Inc. JDescription of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. I am the President of Lee Engineering, which does not have a current or anticipated contract with Colleyville, but Lee Engineering has performed work unrelated to Colleyville, for CP&Y, Inc., and CP&Y, Inc. has performed work for Lee Engineering within the past 12 months. In addition, Kyle Short participated in CP&Y's summer intern program in 2015. CP&Y, Inc. may or may not have a current contract with Colleyville. J List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12 -month period described by Section 176.003(a)(2)(B). Date Gift Accepted Na Description of Gift n/a Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) J AFFIDAVIT I swear under penalty of perjury that the above statement is true and correct. I acknowledge that the disclosure applies to each family member (as defined by Section 176.001(2), Local Government Code) of this local government officer. I also acknowledge that this statement VP('covers the 12 -month period described by Sectio176.003(a (2)(B), Local Government Code. Katherine Wright f./ '!‘,3, *, 06 Commission Expires � 020 Vit i .'Q ID No. 130 / / 9rF'oF�} ID No. 130723546 ` / Signature of Local Government Officer AFFIX NOTARY STAMP / SEAL ABOVE [ /�� may,, 1 Sworn to and subscribed before me, by the said `50c%4 Cr Ol this the day of November20 16 , to certify which, witness my hand and seal of office. 1Nb6ic- I tic ,^, citAv NW `1) Lu oA-v\ XIVle, Wit NOUN Signature of officer administering oath Printed name of officer ackiinistering oath Title of officer administering oath Form provided by Texas Ethics Commission www.eth ics.state .tx. us Revised 11/30/2015 LOCAL GOVERNMENT OFFICER FORM CIS CONFLICTS DISCLOSURE STATEMENT (Instructions for completing and filing this form are provided on the next page.) This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session. OFFICE USE ONLY This is the notice to the appropriate local governmental entity that the following local government officer has become aware of facts that require the officer to file this statement Date Received .............................. in accordance with Chapter 176, Local Government Code. i_ f Name of Local Government Officer Amy Shelley, Colleyville City Secretary nCr T 06 2016 2 Office Held CITY SECRETARY'S OFFICE Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code DOCUNAV SOLUTIONS q I Description of the nature and extent of each employment or other business relationship and each family relationship with vendor named in item 3. Document repository vendor 5 List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted from vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B). Date Gift Accepted 12/06/2016 Description of Gift Tin of cookies - 42 count Date Gift Accepted Description of Gift Date Gift Accepted Description of Gift (attach additional forms as necessary) AFFIDAVIT I swear under penalty of that the disclosure applies Government Code) of this covers the 12-month perio perjury that to each local government described eh the above family by Section statement is true and correct. I acknowledge member (as defined by Section 176.001(2), Local officer. I also acknowledge that this statement 176.003(a)(2)(B), Local Government Code. AFFIX NOTARY STAMP / SEAL ABOVE Sworn to and subscribed before me, by the said Alen`' c)T `�k�`r e‘? Signature of L,t Government Officer , this the 10 day of1b eeerhbet 20 114 to certify which, witness my hand and seal of office. ('.Yl•+-�4 rV 0/\12.1s4-111e.J 1aVe"... No-{—aI Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath Form provided by Texas Ethics Commission www.eth ics. state .tx. us Revised 11/30/2015