o;f intt;res,. qu~~tio~natri;1 entitw·.(the law requires that you the an updated completed...

10
.10"" u "" , •.••• •• , ) .' " ) ,,' ,CONFL.ICT O;F INTt;RES,. , ' " _' "' Fur Vtirldor f,r P'&l'8O" do,"g with iobal entitW· . . :l' t"' t·. - . ..' Thea qusst'onnarre Is berng fired 111 a«:ord'finC6 wnh ch&pler 176 or th.e GOVGmmont Codo by .0 person dolno busfneBS wHh the' gowmmsmal entity. By laVi t.hl' quesllannalte n ..st be ftlad the reOOfds ,admr.,lslratot Qf the tCC4lJ government 'lOt rater '''an th& 7th, bualno@ls"day aft", ttie date 1he beoomee of.'taci& (hat I requlm the tllatellloot to be flfed_ &16 Sec:Uon 176.00.e.Loool 'GovernmetU Code. A p9t80n ¢Ommlts an offense If the person Section 176,006. Local Governroont Code. All Offense under thrs uGJOtkm , ra 11 CIa&8 C mrsdome... nor, 1 ,Nlma of p9J8On bUilt ...... wUh loiUltgOwt'hmlnl.ltntlty. Charles H, \JI.Jhite o ChcJ.ok .111t bu If 1I'OU Me tUfnlI an tlpdGto to • proVlautl, filed q,I.... . .. .' ... '" " . (Tho law raqum IWIt yOU Me en oompa.4ed quoelJonlNll'r$ ""h 1M f1Rng aulhorllV not &of<lr ilia" , '8oplr)l1'lba'.1 of Iho an aolt.'lly dQltQtlboo In ae.. 178.0oe(a). t.Qoal OOdo.-J.'>llnd!ng and not la1.or tl\al\ thul1h bUsh'UMB dQy dnCol' 1110 deto1ho ortglnellyftfsd Of, , rtlswuratG,), , , , I efflllaUOn or , with m or COJdractor aftflo 1000ai gowrnmm'" , enUty Who midi .. r6CMlmlll1d.tlons '0 a ho,l ooven"usnt omen 01' tho g,owl'nm(lmt 4 n $.ywNh rlIep801 10 Olq)enr:Uwto of mCN16Y. ' , , or 8 tooll GCWfmnUIM ontaor of Ihct 'ooa1QOw,"mttltf.t ."lIlY IIW: I. th. lubltGtofthlt , quoIlUonna'tt. " ..>

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Page 1: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

.10"" u "" , •.••• ~ •• ,

)

.'

"

) ,,'

,CONFL.ICT O;F INTt;RES,. QU~~TIO~NAtRI;1" , ' " _ ' "' Fur Vtirldor f,r 04~ P'&l'8O" do,"g ~'IIM88 with iobal fJ~Yornm&iital entitW·.

• . • :l' t"' • ~. • t·. - ~., . ..'

Thea qusst'onnarre Is berng fired 111 a«:ord'finC6 wnh ch&pler 176 or th.e Loo~ GOVGmmont Codo by .0 person dolno busfneBS wHh the' gowmmsmal entity. By laVi t.hl' quesllannalte n..st be ftlad ~ the reOOfds ,admr.,lslratot Qf the tCC4lJ government 'lOt rater '''an th& 7th, bualno@ls"day aft", ttie date 1he p~ beoomee ~re of.'taci& (hat

I requlm the tllatellloot to be flfed_ &16 Sec:Uon 176.00.e.Loool 'GovernmetU Code. A p9t80n ¢Ommlts an offense If the person ~olate9 Section 176,006. Local Governroont Code. All Offense under thrs uGJOtkm

, ra 11 CIa&8 Cmrsdome...nor, 1 ,Nlma of p9J8On do~ng bUilt...... wUh loiUltgOwt'hmlnl.ltntlty.

Charles H, \JI.Jhite

o ChcJ.ok .111t bu If 1I'OU Me tUfnlI an tlpdGto to • proVlautl, filed q,I....\iIQtl~rw..

.JU.&O~LY

9'1.Q~~II,' . . .' ...

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"

. (Tho lawraqum IWIt yOU Me en tIIId,,~d oompa.4ed quoelJonlNll'r$ ""h 1M ~PP~8te f1Rng aulhorllV not &of<lr ilia"

, '8oplr)l1'lba'.1 of Iho yeRt1orM1~ an aolt.'lly dQltQtlboo In ae..178.0oe(a). t.Qoal ~amm8ll.t OOdo.-J.'>llnd!ng and not la1.or tl\al\ thul1h bUsh'UMB dQy dnCol' 1110 deto1ho ortglnellyftfsd qu~aM8fm'boOomCl& Il)flotll~toCo Of, , rtlswuratG,), ,

,, I D~lIlcidl'.8ach efflllaUOn or , ror~U.onlftlp with m orilpl~ or COJdractor aftflo 1000ai gowrnmm'"

,enUty Who midi.. r6CMlmlll1d.tlons '0 a ho,l ooven"usnt omen 01' tho ~C>IlI g,owl'nm(lmt 4 n$.ywNh rlIep801 10 Olq)enr:Uwto ofmCN16Y. ' ,

, Ilppb~ or ilI~~ 8 tooll GCWfmnUIM ontaor of Ihct 'ooa1QOw,"mttltf.t ."lIlY IIW: I. th. lubltGtofthlt , quoIlUonna'tt. "

..>

Page 2: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

.. ,

) "CONFUCTOFINJERESTQUESTIQNNAIRE, ' , .... '. FORM~CIQ FcJr V$ndor or oc,*" p.,eon doing 'bu-tn88S '\vltlllooal gOvo,nmen~1 ebill{; ::~8'ge 2

". • II ..", , " .. r .. " *.

a· Nillm. Of ~~ caovamlt\e1\1 f,)mM'~ WMln tier hal afftlrauo~or,buBlI1." rtf(lUohlt11p. (crimpl......'~ ..... ,.etlan " onIV1f .... AnswtrClO A, a. orC JI~.) , .:'., ,'., ," •

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ThIs _ron, 10m Ilnc:lLdtl'llJ ~UbPlrW ~ I.~ a.n; ,QUal'be cOlllpli)te<l to't 8~ch omcer\tftb "hom' 'he',..;;"~~'B.UoIl Of blMlIM" tl'IIQiIQnetIp, AllI'C1I ,lIdltlot\(lt INIQGIl to"'If foon CIQ cu. nClooesslY,' , , ,- • " . r' ..... . •• . 1 .'_' I>4

A. ,. thlJ ~~ gowmr'n8I'JtQffcar NImId In thfa B'fJ1l'on reoeIvlAg or IItmly to 4'GOOlve 4rombla tncomG from 11l8:111le1l'ortho qlJOt1rO'IWI"I~ . "

a YelA (J No

D.II ttl& me~ 01.. quoellofM,..MoeM1)9oJ 111oI1~ to f'(JQ(lt~ 'Ill~ rnC4lmo frOOl 01" Ell thl) dfr'Ocilatli 01 h louu1 gl)lJomfnlMlI of11cor MmOO 1.-- thta .ool.tcJn AND Ihe toocobfO tneomo til noalnw1he looaI gQ\l~I'rtI'llQm.1 ClnUItl

DVtMl Cl No

'", ..... Od, th~ Met attIQ qU~~IOil'Inllltre~IMt4Idy.lIba ~'P~ or ~~, ~ln~s ~nU~lIta' Ule IQoa1 goverttmontOtlbr HMJuun amoer or c;lrerAoT. (]r holds an ownoqhlp 01·1 QPO~ ~ mQIO? ,.," . .

[]Ve~ 0 No '

..None

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213/10 ~OMf otl1Bt11Otl dOlnG 'WiIltQ;Wil'! if; QOOANmai"i,~ Charies H: \Mllte I 'v1oe President. Division Manager

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BtI'III'IO)4J; IZ eINtD4IShalMIM.II\Un1IPf> IttMwlJoot,IllII'l ~~" ..~ llIIu.1I tliJnO)'jQlJU '

I

Page 3: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

1

2

3

4

CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other parson doing business with local governmental entity

OFFiCE USE ONLYThis questionnaire is being filed In accordance with chapter 176 of the Local Government Code by a person doing business with the Dale Rocolved governmental entity. By law this questlonnaire 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 Sectlon 176.006, Local Government Code. An offense under this section Is a Class C misdemeanor. Name of person doing business with local governmental entity.

Steve Percival President Durotech LP1

o Chock this box If you are filing an update to a previously flied questionnaIre.

(The law requires that you file an updated completed queslionnalre wllh 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 ths date the originally filed Questionnaire becomes Incomplete or Inaccurate.)

Describe each affiliation or buslnes8 relationship with an employee or contractor of the local governmental entity who makes recommendations to a local government ofJlcsr of the local governmental entity with re8pect to expenditure of money.

N/A

Describe each affiliation or buslnese 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.

N/A

Page 4: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

CONFLICT OF INTEREST QUESTIONNAIRE FORM CIQ For vendor or other person doing business with local governmental entity Page 2

5 Name of local government ortlcer with whom flier has affiliation or buelnees relationship. (Complete this eeetlon only If the answer to A, B, or C 18 YES.)

This secllon, lIem 5 Including subparts A. B. C & 0, must be completed for each omcer with whom the filer has affiliation or business relallonshlp. 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 lhe questionnaire?

D Ves [[] No

8. Is the flier of the questionnaire receivIng or likely to receive taxable Income from or at the dlrecllon of the local government officer Ilamed In this section AND the taxable Income Is not (rom the local governmental entity?

DYes ~ No

C. Is the tiler of this questionnaire affiliated with a corporallon or other business enllly that the local government officer serves as an officer or director, or holds an ownership of 10 percent or more?

DVes 1Kl No

D. Describe each affiliation or business relationship.

o Describe any other atrillation or business relationshIp that might calise a conflict of Intorost.

N/A

7

February 3, 2010 Dale

Page 5: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

1

2

3

4

CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity

FORM CIQ

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. Name of person doing busIness with local governmental entity.

Gamma Construction

o Check this box if you are filing an update to a previously flied questionnaire.

OFFICE USE ONLY

Dale Received

(The law requires that you tHe 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.oo6(a), Local Government Code, is pending and not later than rhe 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)

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.

Gamma Construction does not have any affiliation or bustness relationship with an employee or contractor of the local governmental entity.

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.

Gamma Construction does not have any 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.

Amende<! 01l1:Y2006 Amende<! 01/1312006

Page 6: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity

FORM CIQ Page 2

5 Name of local government officer with whom filer has affiliation or business relationship. (Complete this section only if the answer to A, 8, 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?

DYes D 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?

DYes D No

C. Is the filer of this questionnaire affiliated with a corporation or 01her business entity that the local government officer serves as an officer or director, or holds an ownership of 10 percent or more?

DYes D No

D. Describe each affiliation or business relationship.

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

Gamma Construction does not have any other affiliation or business relationship that might cause a conflict of interest.

7

Siprtarure of person doing business with the governmental entity Date

210212010

Page 7: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity

FORM CIQ

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.

OFFICE USE ONLY

Dale Received

1 Name of person doing business with local governmental entity.

Miner-Dederick Construction, LLP

2

o 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.)

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.

Miner-Dederick does not have a conflict of interest with the Lone Star College System.

4 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.

Miner-Dederick does not have a conflict of interest with the Lone Star College System.

Amended 01/1312006 Amended 01/1312006

Page 8: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

5

6

7

CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity

FORM CIQ Page 2

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?

DYes D 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?

DYes D No

C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer or director, or holds an ownership of 10 percent or more?

DYes D No

D. Describe each affiliation or business relationship.

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

None

----Y~~~ Signature of person doing bU~7S with the governmental entity

Thad S. Miner, CEO

February 3, 2010 Date

Page 9: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity

FORM CIQ

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.

OFFICE USE ONLY

Date Received

1 Name of person doing business with local governmental entity.

Joseph P. Glowacki

2

o Check this box if you are filing an update to a previously flied 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.)

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 locaf governmental entity with respect to expenditure of money.

There are none.

4 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.

There are none.

Amonded 01f13i2006 Amend'ed 0111312006

Section 00 43 J2 CSPU I0-515Tomball Main Campus, Renovations and Infrastructure Page 18

Page 10: O;F INTt;RES,. QU~~TIO~NAtRI;1 entitW·.(The law requires that you tHe an updated completed questionnaire with the appropriate filing authority not later than September 1 of the year

5

6

7

CONFLICT OF INTEREST QUESTIONNAIRE For vendor or other person doing business with local governmental entity

FORM CIQ Page 2

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, S, 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?

D Ves D No

S. 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?

Dves o No

C. Is the filer of this questionnaire affiliated with a corporation or other business entity that the local government officer serves as an officer or director, or holds an ownership of 10 percent or more?

Dves D No

D. Describe each affiliation or business relationship.

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

There are none.

\~\~ Signature of ~ tsorttJoih'fBusiness with the governmental entity

Josep~ P. Glowacki Vice qresident, General Manager Turner Construction

Februarv 2, 2010 Dale

Seciion0043 12 CSPNIO-5IHomball Main Campus, Renovations and InfraslTlJcturc Page 19