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Conflict-of-Interest Questionnaires
CONFLICT-OF-INTEREST QUESTIONNAIRE FOR VENDORS
Chapter 176 of the Local Government Code requires the filing of Conflict-of-Interest Questionnaires by certain individuals and businesses. The law applies to businesses and individuals who contract with the District, businesses and individuals who seek to contract with Central Health (regardless of whether a bidder is awarded the contract), and agents who represent such businesses in their dealings with Central Health.
A vendor should use the questionnaire to disclose certain business and gift-giving relationships with the Board of Managers. A list of government officers about whom filers need to disclose is provided below. If a Conflict-of-Interest Questionnaire is not filed together with a proposal or other bid submitted to Central Health, a Conflict-of-Interest Questionnaire must be filed with the District no later than the seventh business day after the person becomes aware of facts that require a statement to be filed.
Filers are also required to complete and submit an updated completed questionnaire no later than the seventh business day after the date on which the originally-filed questionnaire becomes incomplete or inaccurate.
CONFLICT-OF-INTEREST STATEMENT FOR OFFICIALS
Members of the Central Health Board of Managers are required to file a Conflict-of-Interest Statement if they or certain family members have similar business or gift-giving relationships with individuals doing business or seeking to do business with Central Health.
Legal Information Is Not Legal Advice. This site provides some information about the law. Although we try to make sure our information is accurate and useful, we strongly recommend you consult an attorney if you want professional assurance that our information, and your interpretation of it, is appropriate to your particular situation. Therefore, if you require advice about compliance, please consult your attorney.
FREQUENTLY ASKED QUESTIONS
CONFLICT-OF-INTEREST QUESTIONNAIRE
Basic instructions for form completion
QUESTION 1
Name of person who has a business relationship with local governmental entity.
The term person includes partnerships, corporations, and other corporate bodies as applied to these disclosure requirements. Additionally, third-party individuals who act as agents under agency law for a legal entity contracting or seeking to contract with the local governmental entity are independently subject to these disclosure requirements.
QUESTION 2
Check this box if you are filing an update to a previously filed questionnaire.
For new contractors, this may apply if a CIQ was submitted with a RFP / RFQ / RFS response. If – as a new or continuing contractor – you have previously filed a CIQ with the District and the original filing has become incomplete or inaccurate, check the box and update your information.
Otherwise, this question would not apply and is left blank.
QUESTION 3
Name of local government officer with whom filer has employment or business relationship.
Contracts with Central Health are between an individual or entity / organization and Central Health; Central Health officers (as listed below) are not parties to these business relationships.
If a contract with Central Health is your only relationship with Central Health and its officers, this question would not apply and is left blank.
Otherwise, list the name of the individual Central Health official with whom you have a business relationship as described by the Texas Ethics Commission (http://www.ethics.state.tx.us/whatsnew/conflict_forms.htm) and answer questions 3A – D.
List of Central Health officials in response to Question 3 (A, B, C, D)
Bobbie Barker
Brenda Coleman-Beattie
Thomas B. Coopwood, M.D.
Katrina Daniel
Anthony Haley
Clarke Heidrick
Rosie Mendoza, CPA
Donald Patrick, M.D., J.D.
Frank Rodriguez
Patricia A. Young Brown
QUESTION 4
Sign and date
Return completed CIQ to: Records Administrator, Central Health
1111 E Cesar Chavez, Austin TX 78702
(email to: kay.williams@traviscountyhd.org)
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