DBD(EXHIBIT) - EMPLOYMENT REQUIREMENTS AND RESTRICTIONS: CONFLICT OF INTEREST

Note: See the following pages for forms to be used by employees for disclosing potential conflicts of interest as defined in Local Government Code 171.002 and Government Code Chapter 553, Subchapter A.

ADDITIONAL DISCLOSURE: The conflicts disclosure statement required of the College President and, as applicable, a College District employee, as required by Local Government Code 176.003, is available on the Texas Ethics Commission website.

Exhibit A—Affidavit Disclosing Substantial Interest in aBusiness Entity or in Real Property

STATE OF TEXAS

COUNTY OF _______________________________

I, _____________________________ (name), as an employee of the ______________ College District, make this affidavit and hereby on oath state the following: I have a substantial interest in:

a business entity, as those terms are defined in Local Government Code Sections 171.001–171.002, that would experience a special economic effect distinguishable from its effect on the public by an action of the Board or the College District. [See BBFA]

or

real property for which it is reasonably foreseeable that an action of the Board or College District will have a special economic effect on the value of the property distinguishable from its effect on the public.

The business entity or real property is (name/address of business or description of property): ________________________________________________________________________.

I, _________________________ , have a substantial interest in this business entity or real property as follows: (check all that apply)

Ownership of ten percent or more of the voting stock or shares of the business entity.

Ownership of ten percent or more of the fair market value of the business entity.

Ownership of $15,000 or more of the fair market value of the business entity.

Funds received from the business entity exceed ten percent of my gross income for the previous year.

Real property is involved and I have an equitable or legal ownership with a fair market value of at least $2,500.

The statements contained herein are based on my personal knowledge and are true and correct.

Signed this _______ day of __________________________ (month), _______ (year).

______________________________________Signature of employee

______________________________________Title

Acknowledgment

STATE OF TEXASCOUNTY OF _____________________

Sworn to and subscribed before me on this ______ day of __________ (month), ______ (year).

_____________________________________Notary Public in and for the state of Texas

Note: This affidavit should be filed with the College President, Board President, or a designee before the Board takes action concerning the business entity or real property.

Exhibit B—Affidavit Disclosing Interest in Property

STATE OF TEXAS COUNTY OF _____________________

I, _____________________________ (name), as College President of the ______________ College District, make this affidavit and hereby on oath state the following:

I have a legal or equitable interest in property to be acquired with public funds, either by purchase or condemnation.

The property is described as follows:

_________________________________________________________________________.

The nature, type, and amount of interest, including but not limited to, percentage of ownership, I have in the property is:

_________________________________________________________________________.

The interest was acquired on ___________________________ (date).

I swear that the information in this affidavit is personally known by me to be correct and contains the information required by Section 553.002, Government Code.

Signed this ________ day of _____________________ (month), _______ (year).

Acknowledgment

STATE OF TEXASCOUNTY OF ________________________________

BEFORE ME, ___________________ (here insert the name and character of the officer administering the oath) on this day personally appeared _____________________________ (affiant) known to me (or proved to me on the oath of ________________________ or through _________________) (description of identity card or other document) to be the person whose name is subscribed to the foregoing instrument and acknowledged to me that he executed the same for the purposes and consideration therein expressed.

Given under my hand and seal of office this _______ day of ___________________ (month), _____________ (year).

_____________________________________Notary Public in and for the state of Texas

Note: This affidavit should be filed with the county clerk(s) within ten days before the date on which the property is to be acquired, as provided by Government Code 553.002.

Western Texas College

DBD(EXHIBIT)-AJC

UPDATE 31

DATE ISSUED: 3/14/2016