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...... .................. . . . . . . ....... CONFLICT OF INTEREST QUESTIONNAIRE FORM CIO For vendor doing business with iocal governmental entity ..................... . . . ........ This questionnaire reflects changes made to the low by H.S. 21, 641h tog., Regular Sossion. j OFACEUSEONLY This questionnaire Is being god in accordance with Chapter 176. Local Government Code, by a vendor who '"&'Ite �RewWW has a business relationship as dafted by Section 175,00141-0) with a local governmental entity and Ike vendor meets rGquW=nts under Section t 76-008(a). By low this quostionnalre mud be Cited with the records adrWnIstralor of the local governmental enlify not later than the 71h business day after the date the vendor becomes aware of facts that require the statement to be Bled. See Section 176.006(&1). Local Gaimmment Code. A vendor commlis an offense 9 the vendor knowingly violates Section 176.006, Local Government Code. An dense under ibis section Is a mledernoarm. J .' --. T . 1- ........ . . . ...................................................................... l Nameo�e ;'w'ho has a business relationship with local governmental entity, Richard Drake Construction Company L.P. . ......... Check this box 11you are filing an update 10 a previously Flied questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing aulhoft not later than the 711h business day after the date on which you became aware that the originally flied questionnaire was Incomplete or Inaccurate.) mririr.. ......................................... ............... . . . . . ................ ..................... . . ..................... . ..... . . . ...... . . . . . ............ ...... .................................... . . . . . .. . . . ................................................. . . ... . . . . ..... Name of local government off about whom the Information Is being disclosed. NONE . ....... . ........................... Name of Officer . . . . . ............................................ . . . . ....... . ................. . . Qascribe each employment or other business relationship with the loco] government officer, or a family member oftho . . . . ............................. . . . . . . .. .. .. . ............. officer, as described by Section 11743,01113(s)(2XA). Also describe any family relationship with the local government officer. Complete subparts A and S for each employment or business relationship described. Altachaddillonall pages to this Form CIO as necessary. N/A A. Is the local government officer or a famfiy member of the officer receiving or likely to receive taxable Income, other than Investment Income, from the vendor? n yes ID No S. Is the vendor receiving or likely to receive taxable Income, other than Investment Income, from or Ed the direction of the local government officer or a family member of the officer AND the taxable Income Is not received from the local governmental entity? r-1 Yes F-1 No employment ... ... . . . --- . . . . . .......................................... ..-- ............... Describe each ment or business relationshipwwwww government vendor Irl Section I maintains with a corporation at other business entity with respect tow the local government officer serves as an officer or director, or holds an ownership Interest of one percent or more. NONE . ...... ........... ............. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .......................................... . . . . . ........................ ...... . ..... . . . . . . . ....................... - -- - -------- - . . . . . . .. . .. . .. . . . . . ........................................... . .. . .. ❑Check this box if the vendor has given the local government officer or a family member oilthe officer one or more oft as described In Section 1176.0D3(a)(2)(8), excluding gifts described In Section 176.003(a-1). ?T . . . . . ....................... . ....... . ........... . . . . . . . . . . . . . ................ . ......... - -------- ...................................... . . ............... . . . .... . 04/19/2022 Signature of vendor do] ng business Witk the government R enro7y F6-lm provided #1y Texas Ethics --C" 'o" m -ml a s I on . . . . . . . . .............................. . ....... W`w`w, al-hic, s, -8, -ta" -t e.-I X-" -u-s- . . ........Revised -.......... .................. t1130/2015 Page 9 of 25