HomeMy WebLinkAboutAndrea Nephf Conflict�ot���Ec-r ��'r�°r�r���� c��r���r'c�rv[v�'�� �o�nn �IC�
F�r veead�r d�ing baesis���s with I�c�l g�v�rrrrn�ea#�6 entify
Thls ques4ionn�ire reH�cts ch2rvgea made 40 4he 6aw 6y H.�. 2I, BdYh Leg.,� Regufer $�esdpn. m��EU�EQNLY
This cp�eslianttair� �is 6aing filed in accflfrlance with ChaPi�e 17&, LocaE Gavemmen! Gede, by a vendar whq pa�a Rece�vca �
has a buxlness relefionsh� as detinad by SeclEon 176.00t{i�a) v+ilh a{ocal governmentai entity and the
vendor mae¢s r�qufremenls u�der Seciian i 7$.666(aj. .
Sy�law INs quesEiannaire must bo tii0d�with Ihe�reetrrds administraior of fho iocaf govammemal� enlily ncN latee �
Ihan !he 71h 6usiriess day aNer llrm daie the vendor becames aware ai fscis Ihat require 1he st3lement to be �� �
iii¢d. Sae Secf§�rn 1�76.�O6;a-7j; Local Govemmeert Cale.. . �
A vendvr commd8s an ofEerrse i€. dhe verador knawingiy v;alates SecPlan i7S.Q08, laca��Gaveenmen! Code. ,4n � .
pRense under 9his sectivn is a misdeeneanoc .
� Name of vsndnrvuha has a trusin�ss elatianship wEth isscal govermra�nta9 enflty.
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❑ Ch�ckthls6oz6iyauarefidingaasup�aietp��previousiyti8edques8&onnalre.(ThelabYrequiresthatyouGiean.updated
compteled quesWionnaira with the apprnprlat� fiting authority noI @ster than the 7th b�sinesa day after 1he dafe on which
yau bacarns aware thai 1he or'tgenaCly #iied quesiiannair� was incornp[ete oe inaocurate.j '
� Name oflacat g�vem�aaeaat oBEtcer abosaE w4�orta [he iniorRna4ian is being d4sciase�9.
tV�Ia'�
. Nam� of Utficer . � .
$ bes�ribe each errsp9apm�ni ar otlaer buslesess rela8@oasshlg w3th kh� loc�@ ge+veenmen4 �Ptic�r, ar a taeniPy rc�ember �f 1N�
�f#ieec, �s descrahed 3�y Sectlan'376A03{a}(2}{A}, Ats� descrEbe any face�iEy ra9at[onshi�a rnrt4h PF�e 6ac�i gosternmen� �fficer.
Corarp9ete saabparts A and � Bor each ernploysnerat or business ralet€onshEp descrlbed. �4ri�ch ad�itdaa�ai pages ia 4his �oreas
�8Q a� n�cess�ry.
�
A. Is the Eocal govemment ol4icer or a(2mily member a3 the oiiieer receiving or IEkely ?o rece'we taxa4la income,
other than Invastmant inaorera, frorn tha vendar? �
a Yes �No
8. I� the vendor receiving ar Iikely to rac�ive tazabie income, dther than invesimenl income, from ffr at the direction �
oi ihe local governm�nt oHic�r ar a family memher of the ofiicer ANd? #hs taxab3e income is r.ot eeoeived from fhe
taae! gavernmerr�ai entity7
� Yes Np
5 6��eri6�each emptoyment arbusiness r�la&lo¢as�rip thaf the uendar named i�s Sect€on P meln8a6�as with � corp��ation �r
ather bcs�itsess eaaflitg w6th respecf to �htch the I�eal gaver�srr�eni officer serves as an afftcer or dieec4oe, �e holais a¢t
own�rsh8p [nl�re�t csf one percent �r mare, ���
� r/,
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�Gheak this box if the vendor t�s given the facal gavetnment oiPicer or � famiiy memher of Yhe olficeP one ar rnore giits
�s described in Seciion 1T6.009(a}(2)(8), exoiuding gitts deserihed in Seciion t78.0 3{a-ty.
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_. --'�' �.�_. z� j �
Signafure ol v n br tloi Ig usiness svi?h Ihe govemmenlal entity g(g
Form provitled 6y Texas EthSas CRmmis5ian www.eihics.siate,tx,us #ievisad 91/9tl;2416