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FORMCIQ CONFLICT OF INTEREST QUESTIONNAIRE For veodor or other penoo doing busilless with local goveromeotal entity OFFICE USE ONLy This questlonnaiN reflects changes made to the law by H.B. 1491,

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7th 1-a veodor m-en ved-----1 usin oages 2012 Desaibe penoo Fonn 80th govemment doi busilless Govmment ty recelvlng eal CIQ Seeslon wHh tf goveromeotal RFB FORMCIQ g-ove Oves t--l subparts

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