Contracts Disclosure Form

For details on use of this form, see Section 2-59 through 2-61 of the City's Ethics Code.
Instructions for Completing the Contract Disclosure Form

Inaccurate or incomplete disclosures may affect eligibility.

*This is a:

*This is a: New Submission Correction Update to previous submission

*1) Contract Information

a) Contract or Project Name:

b) Department:

*2) Disclosure of parties, owners, and closely related persons.

PLEASE PROVIDE THE FOLLOWING INFORMATION FOR INDIVIDUAL(S) OR ENTIT(IES) APPLYING FOR A CITY CONTRACT.

a) LEGAL NAME (must match the name that will appear on the contract, if awarded).

b) Name and Title of Authorized Signatory (person who will sign the contract)

Name:

Title:

c) Name of all Owners.

d) Name of all Board Members.

e) Name of all Executive Committee Members.

f) Name of all Officers.

*3) List any individual(s) or entity(ies) that is a partner, parent company, joint venture, or subsidiary entity(ies) of the individual or entity listed in Section 2 above.

Not applicable. Contracting party(ies) does not have partner, parent company, joint venture, or subsidiary entities.
If applicable, list below names and type of relationship (partner, parent company, joint venture or subsidiary entities, and all the owners, board members, executive committee members, and officers of each entity:

*4) Subcontractor Information.

Not applicable. No subcontractors will be retained for this contract.
Subcontractors may be retained, but have not been selected at the time of this submission.
The following subcontractors have been retained for this contract (please list information below):

*5) List any attorneys, lobbyists, or consultants retained by any individuals listed in Questions 2, 3, or 4 to assist in seeking this contract.

Not applicable. No attorneys, lobbyists, or consultants have been retained to assist in seeking this contract.
List of attorneys, lobbyists, or consultants retained to assist in seeking this contract:

*6) Disclosure of political contributions.

List any campaign or officeholder contributions made in the past 24 months by individuals listed in Sections 2, 3, 4 or 5 to any current or former City Council member, candidate for City Council, or specific purpose political action committee (SPAC) formed for the purpose of supporting or opposing a candidate for City Council. Please include any indirect contributions made by a spouse (statutory or common-law) of any individual listed in Sections 2, 3 or 4:

Not applicable. No campaign or officeholder contributions have been made in preceding 24 months by these individuals.
If applicable, list below name of contributor; to whom; date; and amount:

*7) Disclosure of conflict of interest.

Are you aware of any fact(s) with regard to this contract that would raise a "conflict of interest" issue under Sections 2-43 or 2-44 of the City Ethics Code for any City Council member or board/commission member?

I am not aware of any conflict(s) of interest issues under Section 2-43 or 2-44 of the City Ethics Code for members of City Council or a city board/commission.
I am aware of the following conflict(s) of interest:

*8) Service on a City Board or Commission.

Currently, or within the past twelve (12) months, have any individuals listed in Sections 2, 3, or 4, or their spouse, sibling, parent, child, or other first-degree family member by consanguinity or affinity, served on a City board or commission?

If yes, do any of the individuals own 10% or more of the voting stock or shares, or 10% or more of the fair market value of the entity seeking a contract with the City?

Acknowledgements

*1. Updates Required

I understand that this form must be updated by submission of a revised form if there is any change in the information before the discretionary contract, housing and retail development incentive, or the purchase, sale, or lease of real estate to or from the City is the subject of action by the City Council, and no later than 5 business days after any change has occurred, whichever comes first. This includes information about political contributions made after the initial submission and up until 30 calendar days after contract has been awarded.

*2. No Contact with City Officials or Staff during Contract Evalution

I understand that a person or entity who seeks or applies for a city contract or any other person acting on behalf of that person or entity is prohibited from contacting city officials and employees regarding the contract after a Request for Proposal (RFP), Request for Qualification (RFQ), or other solicitation has been released.

*3. Contribution Prohitibitions for "High-Profile" Contracts

This is not a high-profile contract.
This is a high-profile contract. If this is a high-profile contract, please acknowledge the following:

I acknowledge that this contract has been designated as a high-profile contract by the city. I further acknowledge that certain individuals as outlined in Section 2-309 of the Municipal Campaign Finance Code are prohibited from making campaign contributions to any Councilmember, candidate or specific political action committee (SPAC) formed to support or oppose a City Councilmember or candidate from the 10th business day after the solicitation has been released until 30 calendar days after the contract has been awarded.

I warrant that no contributions have been made by these individuals in violation of Section 2-309 of the Municipal Campaign Finance Code.

PENALTY: I acknowledge that if any of the individuals or entities identified in Section 2-309 of the Municipal Campaign Finance Code make a prohibited contribution during the blackout period, the City cannot award the contract to them. Additionally, City Council may void any contract awarded in violation of this provision.

*4. Prohibited Interest in Contracts

I acknowledge that under the City Charter and Ethics Code, City Officers (including members of certain boards and commissions considered “more than advisory” in nature) and certain City Employees, as well as their close family members, and businesses they or their family own (with a 10% or greater interest) are prohibited from obtaining contracts with the City during their service. This includes subcontracts and applies to related businesses. These individuals and their families remain prohibited from obtaining discretionary contracts for one year after leaving City service.

*5. Conflicts of Interest Questionnaire (CIQ)

I understand Chapter 176 of the Local Government Code requires certain contractors and vendors to submit a Conflict of Interest Questionnaire Form (CIQ) to the Office of the City Clerk, even if the contract is not designated as "High Profile". I acknowledge that I have been advised of the requirement.

*Oath

I swear or affirm that the statements contained in this Contract Disclosure Form, including any attachments, to the best of my knowledge and belief are true, correct, and complete.

* Print Name:

* Signature: