CONFLICT OF INTEREST DISCLOSURE

 

As a Director of Communities In Schools of South Central Texas, Inc. Board of Directors and in compliance with the By-laws of the Corporation, the following is made:

 

               I am _________________                 I am not ________________

 

an officer, member, owner or employee of a business or other organization with which Communities In Schools of South Central Texas, Inc., d.b.a. “CIS”, has, or might reasonably in the future enter into a relationship or a transaction in which I would have conflicting interests.

 

If answered in the affirmative, complete the following:

 

My position title is:

 

My duties are, briefly (a complete description of your job, membership duties, copy of employment contract, or any other pertinent information may be attached):

 

My duties include one or more of the following activities in regard to Communities In Schools of South Central Texas, Inc.:

 

signing a bid, proposal or contract;

negotiating a contract;

contracting an officer or employee of the agency for the purpose of

obtaining or negotiating contracts.

Negotiating or discussing changes in specifications, price, cost allowances, or other terms of a contract, or

Settling disputes concerning performance of a contract; or

any other liaison activity with a view toward the ultimate  

consummation of a sale even though the actual contract therefore is subsequently negotiated by another person.

 

           ________No               _______Yes (If answered in the affirmative,

                                                               attach explanatory details).

 

                                                                            

Signature: ________________________________     Date: _________________

 

Printed Name: _____________________________