“Se FR AM AR [IL LO CONFLICT OF INTEREST AGREEMENT ‘The undersigned, being a Board member or officer of the Amarillo Economic Development Corporation (“Amarillo EDC”), confirms that I have read and understood Chapters 171 and 176 of the ‘Texas Local Government Code (regarding conflicts of interest and disclosure of business interests and aifts), am bound thereby, and will faithfully comply with the provisions of such Chapters, Without limiting the generality of such Chapters, in the event I have a conflict of interest as defined by Chapter 171, I will abstain from any discussion, vote, decision, or other participation on the matter. I will also timely execute and deliver to the President of Amarillo EDC an Affidavit on the form attached hereto, Further, on the Local Government Officer Conflicts Disclosure Statement form attached hereto, 1 will timely diselose to Amarillo EDC the existence of any of the following facts or circumstances, with respect to a vendor or potential vendor of Amarillo EDC (each, a “Vendor”): ‘+ have, or anyone related to me within the first degree of blood or marriage (each, a “Family Member”) has, an employment or other business relationship with a Vendor. © A Vendor has given to me or a Family Member gifts (including, without limitation, transportation, food, entertainment, and lodging) in an aggregate value of more than $100 in the 12-month period before the date I became aware that a contract with a Vendor has been entered or is being considered by Amarillo EDC. ‘+ A Vendor is related to me within the third degree of blood or the second degree of marriage, acknowledge thet my disclosure of any of the above-listed facts or circumstances is required to be filed with the President of the Amarillo EDC on or before 5 p.m. on the 7* business day after I become aware of such facts or circumstances, under the terms of Chapter 176 of the Texas Local Goverment Code. Signature Date Print NameAFFIDAVIT (Chap. 171, Tex. Loc. Gov. Code) STATE OF TEXAS ' CITY OF AMARILLO* 1 ‘the Amarillo Economic Development Corpor ‘am a member of the Board of Directors of and upon my oath or affirmation I state the following: “Pursuant to Texas Local Government Code, chapter 171, I hereby disclose there is pending before the above stated board, Council, or other body, a matter on which a vote or decision may produce a special economic effect on (e., different from its effect on the general public) certain real property or a business {in which I have a substantial interest. The business entity or real property involved is as follows: ‘The nature of my substantial interest in the above identified business entity or real property is [check one] [ Jmy own OR [ ] that of a person(s) related to me within the first degree by blood or marriage, ‘Must check all that apply: Real Property [1] As to the real property identified above, I or ‘my relative have an equitable or legal ownership interest with a fair market value of at least $2,500. Business Entity As to the business entity identified above, I or nny relative []_ Stook: own 10% or more of the voting stock or shares of the business. [1 Yalue: own 10% or $15,000 or more of the fair market value of the business. [1]. Income: received funds from the ‘business which exceed 10% of (my/his/her) {gross income for the previous year. T have and shall continue to abstain from any discussion, vote, decision, or other participation on the ‘matter involving the above identified business entity or real property, and I direct that this affidavit be filed with the President of the Amarillo Economic Development Corporation.” Signed this day of, 20. BEFORE ME, the undersigned authority, personally appeared on the day of. 20___, and by oath or affirmation he/she did state that the facts recited above are true and correct. ‘Notary Public in and for the State of TexasLOCAL GOVERNMENT OFFICER Form CIS CONFLICTS DISCLOSURE STATEMENT {instucons for comploting nln this lm are ord on he next p90.) This quvsionnate ries changos mado ov lw by Wi. 2A Ban Log, Requlr Beeson. This is the notice to the approgriale local governmental entity that the folowing local government officer has become aware of facts that require the officer to file this statement ‘accordance wits Chapter 176, Local Government Code, Namo of Local Government Officer Office Heid Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code |x] Description ofthe nature and extent of each employment or other business re jonship and each family relationship with vondor named in tom 3. [5] List its accapied by tho local government officer and any family member, aggregate value of he gis accepind {romvondor named in tom 3 oxeneds 5100 during the 12-month poiod described by Section 176 0003)(2(8) ate Gin Accapted Description ot itt DateGit Accacted_ Description ot ct Date Gin Accacted Doser not i_ (aiach addiional forme as necessary 6] AFFIDAVIT: fT ane | swear under penaily of penury that he above statements tue and correct | acknowledge thre Gace apples tach fay rnb as ted by Secon T7001) eel ‘Goverment Cogs the teal gvermert ices. | ao acknowl in Set conrsthe moh pened denon oy Sesion 1750081240) orl Goverment Coe ‘Sires & Loos Goverment nae See to cy arse, aanass my ran ana soa 9. Fom provide Torat Ethie: Commmanen ewan state tae nrozms