Common use of Conflict of Interest Questionnaire Clause in Contracts

Conflict of Interest Questionnaire. If you have a conflict of interest as described in this form No FORM CIQ or the Local Government Code Chapter 176, cited therein- you are required to complete and file with TIPS, Xxxxxxx Xxxxxx, 0000 XX Xxxxxxx 000 Xxxxx, Xxxxxxxxx, Xxxxx 00000 You may find the Blank CIQ form on our website at: Copy and Paste the following link into a new browser or tab: xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf Do you have any conflicts under this statutory requirement? 50 Filing of Form CIQ If yes (above), have you filed a form CIQ as directed here? 51 Regulatory Standing I certify to TIPS for the proposal attached that my Yes company is in good standing with all governmental agencies Federal or state that regulate any part of our business operations. If not, please explain in the next attribute question. 52 Regulatory Standing Regulatory Standing explanation of no answer. 53 Antitrust Certification Statements (Tex. By submission of this bid or proposal, the Bidder certifies (No Response Required) Government Code § 2155.005) that: I affirm under penalty of perjury of the laws of the State of Texas that:

Conflict of Interest Questionnaire. If you have a conflict of interest as described in this form No FORM CIQ or the Local Government Code Chapter 176, cited therein- you are required to complete and file with TIPS, Xxxxxxx Xxxxxx, 0000 XX Xxxxxxx 000 Xxxxx, Xxxxxxxxx, Xxxxx 00000 You may find the Blank CIQ form on our website at: Copy and Paste the following link into a new browser or tab: xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf Do you have any conflicts under this statutory requirement? 50 Filing of Form CIQ If yes (above), have you filed a form CIQ as directed here? 51 Regulatory Standing I certify to TIPS for the proposal attached that my Yes company is in good standing with all governmental agencies Federal or state that regulate any part of our business operations. If not, please explain in the next attribute question. 52 Regulatory Standing Regulatory Standing explanation of no answeranswer on previous question. 53 Antitrust Certification Statements (Tex. By submission of this bid or proposal, the Bidder certifies (No Response Required) Government Code § 2155.005) that: I affirm under penalty of perjury of the laws of the State of Texas that:

Conflict of Interest Questionnaire. If you have a conflict of interest as described in this form No FORM CIQ or the Local Government Code Chapter 176, cited therein- you are required to complete and file with TIPS, Xxxxxxx Xxxxxx, 0000 XX Xxxxxxx 000 Xxxxx, Xxxxxxxxx, Xxxxx 00000 You may find the Blank CIQ form on our website at: Copy and Paste the following link into a new browser or tab: xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf Do you have any conflicts under this statutory requirement? 50 Filing of Form CIQ If yes (above), have you filed a form CIQ as directed here? No 51 Regulatory Standing I certify to TIPS for the proposal attached that my Yes company is in good standing with all governmental agencies Federal or state that regulate any part of our business operations. If not, please explain in the next attribute question. 52 Regulatory Standing Regulatory Standing explanation of no answer. 53 Antitrust Certification Statements (Tex. By submission of this bid or proposal, the Bidder certifies (No Response Required) Government Code § 2155.005) that: I affirm under penalty of perjury of the laws of the State of Texas that:

Conflict of Interest Questionnaire. If you have a conflict of interest as described in this form No Yes FORM CIQ or the Local Government Code Chapter 176, cited therein- you are required to complete and file with TIPS, Xxxxxxx Xxxxxx, 0000 XX Xxxxxxx 000 Xxxxx, Xxxxxxxxx, Xxxxx 00000 You may find the Blank CIQ form on our website at: Copy and Paste the following link into a new browser or tab: xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf Do you have any conflicts under this statutory requirement? 50 52 Filing of Form CIQ If yes (above), have you filed a form CIQ as directed here? 51 Yes 53 Regulatory Standing I certify to TIPS for the proposal attached that my Yes company is in good standing with all governmental agencies Federal or state that regulate any part of our business operations. If not, please explain in the next attribute question. 52 54 Regulatory Standing Regulatory Standing explanation of no answeranswer on previous question. 53 55 Antitrust Certification Statements (Tex. By submission of this bid or proposal, the Bidder certifies (No Response Required) Government Code § 2155.005) that: I affirm under penalty of perjury of the laws of the State of Texas that:

Conflict of Interest Questionnaire. If you have a conflict of interest as described in this form No FORM CIQ or the Local Government Code Chapter 176, cited therein- you are required to complete and file with TIPS, Xxxxxxx Xxxxxx, 0000 XX Xxxxxxx 000 Xxxxx, Xxxxxxxxx, Xxxxx 00000 You may find the Blank CIQ form on our website at: Copy and Paste the following link into a new browser or tab: xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf Do you have any conflicts under this statutory requirement? 50 Filing of Form CIQ If yes (above), have you filed a form CIQ as directed here? Yes 51 Regulatory Standing I certify to TIPS for the proposal attached that my Yes company is in good standing with all governmental agencies Federal or state that regulate any part of our business operations. If not, please explain in the next attribute question. 52 Regulatory Standing Regulatory Standing explanation of no answer. 53 Antitrust Certification Statements (Tex. By submission of this bid or proposal, the Bidder certifies (No Response Required) Government Code § 2155.005) that: I affirm under penalty of perjury of the laws of the State of Texas that:

Conflict of Interest Questionnaire. If you have a conflict of interest as described in this form No FORM CIQ or the Local Government Code Chapter 176, cited therein- you are required to complete and file with TIPS, Xxxxxxx Xxxxxx, 0000 XX Xxxxxxx 000 Xxxxx, Xxxxxxxxx, Xxxxx 00000 You may find the Blank CIQ form on our website at: Copy and Paste the following link into a new browser or tab: xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf Do you have any conflicts under this statutory requirement? 50 Filing of Form CIQ If yes (above), have you filed a form CIQ as directed here? Yes 51 Regulatory Standing I certify to TIPS for the proposal attached that my Yes company is in good standing with all governmental agencies Federal or state that regulate any part of our business operations. If not, please explain in the next attribute question. 52 Regulatory Standing Regulatory Standing explanation of no answeranswer on previous NA question. 53 Antitrust Certification Statements (Tex. By submission of this bid or proposal, the Bidder certifies (No Response Required) Government Code § 2155.005) that: I affirm under penalty of perjury of the laws of the State of Texas that:

Conflict of Interest Questionnaire. If you have a conflict of interest as described in this form No Yes FORM CIQ or the Local Government Code Chapter 176, cited therein- you are required to complete and file with TIPS, Xxxxxxx Xxxxxx, 0000 XX Xxxxxxx 000 Xxxxx, Xxxxxxxxx, Xxxxx 00000 You may find the Blank CIQ form on our website at: Copy and Paste the following link into a new browser or tab: xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf Do you have any conflicts under this statutory requirement? 50 52 Filing of Form CIQ If yes (above), have you filed a form CIQ as directed here? 51 Yes 53 Regulatory Standing I certify to TIPS for the proposal attached that my Yes company is in good standing with all governmental agencies Federal or state that regulate any part of our business operations. If not, please explain in the next attribute question. 52 54 Regulatory Standing Regulatory Standing explanation of no answeranswer on previous Not Applicable question. 53 55 Antitrust Certification Statements (Tex. By submission of this bid or proposal, the Bidder certifies (No Response Required) Government Code § 2155.005) that: I affirm under penalty of perjury of the laws of the State of Texas that:

Conflict of Interest Questionnaire. If you have a conflict of interest as described in this form No Yes FORM CIQ or the Local Government Code Chapter 176, cited therein- you are required to complete and file with TIPS, Xxxxxxx Xxxxxx, 0000 XX Xxxxxxx 000 Xxxxx, Xxxxxxxxx, Xxxxx 00000 You may find the Blank CIQ form on our website at: Copy and Paste the following link into a new browser or tab: xxxxx://xxx.xxxx-xxx.xxx/assets/documents/docs/CIQ.pdf Do you have any conflicts under this statutory requirement? 50 Filing of Form CIQ If yes (above), have you filed a form CIQ as directed here? No 51 Regulatory Standing I certify to TIPS for the proposal attached that my Yes company is in good standing with all governmental agencies Federal or state that regulate any part of our business operations. If not, please explain in the next attribute question. 52 Regulatory Standing Regulatory Standing explanation of no answer. 53 Antitrust Certification Statements (Tex. By submission of this bid or proposal, the Bidder certifies (No Response Required) Government Code § 2155.005) that: I affirm under penalty of perjury of the laws of the State of Texas that: