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

Transcription

1 2 3 4 CONFLCT OF NTEREST QUESTONNARE 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 , Local Government Code. A person commits an offense if the person violates Section , Local Government Code. An offense under this section is a Class C misdemeanor. Name of person doing business with local governmental entity. ANGEL Learning, nc. D Check this box if you are filing an update to a previously filed questionnaire. NONE FORM CQ Page 1 of 2 OFFCE USE ONLY Received (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 (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.) 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. 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, \;' '<,,/

2 5 6 7 CONFLCT OF NTEREST QUESTONNARE D No O. Describe each affiliation or business relationship FORM CQ B. s 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? Page 2 of 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 CQ as necessary. A. s the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? C s 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? Describe any other affiliation or business relationship that might cause a conflict of interest. NONE Signature of person doing b~ess with the governmental entity January 8, 2009

3 CONFLCT OF NTEREST QUESTONNARE 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 , Local Government Code. A person commits an offense if the person violates Section , Local Government Code. An offense under this section is a Class C misdemeanor. 1 Name of person doing business with local governmental entity. FORM CQ Page 1 of 2 OFFCE USE ONLY Received 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 (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. 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. Page 36 of 37

4 CONFLCT OF NTEREST QUESTONNARE FORM CQ Page 2 of 2 5 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 CQ as necessary. A. s the local govemment officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? lrlno B. s 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? C. s 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? D. Describe each affiliation or business relationship. 6 Describe any other affiliation or business relationship that might cause a conflict of interest. 7 January Page 3~ of37

5 Lone Star College System- January 12, 2009 EXHBT C EXHBT C Request for Proposal No Request to Purchase - Online Learning Management System Proposal Opening: 10:00 a.m., Monday, January 12,2009 SGNATURE PAGE ]n compliance with this Request for Proposal, the undersigned agrees to furnish the services in accordance with the attached Statement of Work and Base Bid Proposal or as mutually agreed by subsequent negotiation. Desire2learn ncorporated Company Submitting Proposal 305 King Street West, Suite 200 Kitchener Ontario N2G B9 Address City State/Province Zip/Postal Code Phone Number Fax Number Steven.Rutherford@Desire2Learn.com Bill Trick Authorized Person Submitting Proposal (Print) ~O Signature~ Web Address Manager of Financial Services Title January 8, 2009 BDS WLL ONLY BE ACCEPTED ON LSCS'S EXHBT "B" BD PROPOSAL FORM. BD PROPOSALS MUST BE COMPLETED WTH UNT PRCE (F APPLCABLE) & TOTAL PRCE. BD PROPOSALS WLL BE CONSDERED NON-RESPONSVE F T S NOT SUBMTTED ON TillS FORM AS REQUESTED. 27

6 Lone Star College System- January 12, 2009 CONFLCT OF NTEREST QUESTONNARE FORMCQ Page 2 of2 5 Name of local government officer with whom filer has afliliation or business relationship. (Complete this section only if the answer to A, B, or C is YES.) N/A 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 CQ as necessary. A. s the local govemment officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? D No B. s 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? C. s the filer of this questionnaire affiliated with a corporation or other business entity that the local govemment officer serves as an officer or director, or holds an ownership of 10 percent or more? D. Describe each affiliation or business relationship. 6 Describe any other afliliation or business relationship that might cause a connict of interest. 7 N/A Signature of persv1ng business with the govemmenta[ entity 29

7 CONFLCT OF NTEREST QUESTONNARE FORM CQ Page 1 of 2 This questionnaire is being filed in accordance with chapter 176 of the OFFCE USE ONLY Local Government Code by a person doing business with the Received 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 , Local Government Code. A person commits an offense if the person violates Section , Local Government Code. An offense under this section is a Class C misdemeanor. 1 Name of person doing business with local governmental entity. 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 (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. We- do no! ~~"!LMe tiltha-h'mt ay ~~/'rtec.s t'd~jtt5l.:~5 ~~ cwr ~' '~ee- tjv {!(JJthdovel~ / rvy -.".11 /. ~ 1--1"iJ/w MA~ /?! C-tm t~d~.:h cjjt~ / OC()/{ J~&r11~ ~'t7j ~/ /,10 -fzj. a :0ca 1Wt:-Wl~ 9$c / 0+~ 1'ta. 1 3crV"(iV(1 ea J VJlffl "~ped- -!tj expud'4re. ~ ~' 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.

8 For CONFLCT OF NTEREST QUESTONNARE FORM CQ vendor or other person doing business with local governmental entity Page 2 of 2 5 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 CQ as necessary. A. s the local government officer named in this section receiving or likely to receive taxable income from the filer of the questionnaire? D No B. s 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? C. s the filer of this questionnaire affiliated with a corporation or other business entity that the local govemment officer serves as an officer or director, or holds an ownership of 10 percent or more? D. Describe each affiliation or business relationship. 6 Describe any other affiliation or business relationship that might cause a conflict of interest. 7.t<e cue tujf dptl/e. 0(r:r; tl#}'a. -h~'( "rtdt:l!, 'em {vf5 <-f!ld- ru~y CCULJe &7 1d.0~f tzf c./t~ h~ ~ ~ S(~c;. Cd1Clc. f et2 Signature of person doin~usiness with the governmental entity