Notice to Vendors
Conflict of Interest Disclosure Statements
Texas Local Government Code, Chapter 176
Vendors are required to file a Conflict of Interest Questionnaire with the District if a relationship exists between the
vendor’s company and an officer of the District. Vendors are encouraged to review and become familiar with all
disclosure requirements of Texas Local Government Code, Chapter 176.
Conflicts of interest exist if:
1. the person has employment or other business relationship with the local government officer or a family member
resulting in the officer or family member receiving taxable income; or
2. the person has given the local government officer or family member one or more gifts (excluding food, lodging,
transportation, and entertainment) that have an aggregate value of more than $250 in the twelve-month period
preceding the date the officer becomes aware of an executed contract or consideration of the person for a
contract to do business with the District.
Disclosure is required from vendors regarding each affiliation or business relationship between the vendor and:
1. an officer of the District.
2. an officer of the District that results in the officer or family member receiving taxable income.
3. an officer of the District that results in the vendor receiving taxable income that does not come from the District.
4. a corporation or other business entity in which an officer of the District serves as an officer or director or
holds an ownership interest of 10% or more.
5. an employee or contractor of the District who makes recommendations to an officer of the District regarding
the expenditure of money.
6. an officer of the District who appoints or employs an officer of the District that is the subject of the questionnaire;
7. any person or entity that might cause a conflict of interest with the District.
Forms must be filed:
1. No later than the seventh business day after the date that the person begins contract discussions or
negotiations with the government entity, or submits to the entity an application, response to a request for
proposal or bid, correspondence, or other writing related to a potential agreement with the entity.
2. The Vendor also shall file an updated questionnaire:
a. not later than September 1 of each year in which a covered transaction is pending, and
b. the seventh business day after the date of an event that would make a statement in the questionnaire
incomplete or inaccurate.
3. A vendor is not required to file an updated questionnaire if the person had filed an updated statement on or
after June 1, but before September 1 of the year.
Officers of the Irving Independent School District are
Randy Randle, Board President, (District 7)
Nuzhat Hye, Vice President (District 4)
Pam Campbell, Secretary (District 3)
Dr. Rosemary Robbins (District 1)
Michael Kelly (District 2)
A.D. Jenkins (District 5)
Tony Grimes (District 6)
Magda Hernandez, Superintendent of Schools
If you are required to file, send the completed form to Irving Independent School District,
Purchasing Department, 2621 West Airport Freeway, Irving, Texas 75062.
CONFLICT OF INTEREST QUESTIONNAIRE
For vendor or other person seeking to do business with local governmental entity
Name of Person Completing Form:
Name of Company Completing Form:
This questionnaire reflects changes made to the law by H.B. 1491, 80th Leg., Regular Session.
This questionnaire is being filed in accordance with Chapter 176, Local Government Code by a person
who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and
the person meets requirements under Section 176.006(a).
By law this questionnaire must be filed with the records administrator of the local governmental entity 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 176.006, Local Government Code.
A person commits an offense if the person knowingly violates Section 176.006, Local
Government Code. An offense under this section is a Class C misdemeanor.
1 Name of person who has a business relationship with local governmental entity.
OFFICE USE ONLY
Date Received: / /
2 Check this box if you are filling 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 the 7th business day after the date the originally filed questionnaire becomes incomplete or inaccurate.)
has employment or business relationship:
(List Name of Officer in space provided above)
If naming government officer above, completion of A, B, C & D below is required. If no conflict, check box at line 4 below.
This section (item 3 including subparts A, B, C & D) must be completed for each officer with whom the filer has affiliation or business
relationship as defined by Section 176.001(1-a), Local Government Code. Attach additional pages to this Form CIQ as necessary.
A. Is the local government officer named in this section receiving or likely to receive taxable income, other than investment income,
from the filer of the questionnaire?
B. Is the filer of the questionnaire receiving or likely to receive taxable income, other than investment income, from or at the direction
of the local government officer named in this section AND the taxable income is not received from the local governmental entity?
C. Is the filer of this questionnaire employed by a corporation or other business entity with respect to which the local
government officer serves as an officer or director, or holds an ownership of 10 percent or more?
D. Describe each employment or business relationship with the local government officer named in this section.
Check here if you are NOT reporting a conflict with any government officer of Irving ISD