91275-002 476034v1 Page 1 of 2
HARRIS COUNTY MUNICIPAL UTILITY DISTRICT NO. 275
NOTICE OF PUBLIC MEETING
Notice is hereby given to all interested parties that the Board of Directors of the captioned District will hold a public meeting by telephone conference call. Members of the public may access the meeting by following the instructions listed at the bottom of this notice.
The meeting will be held at 12:00 p.m. on Wednesday, June 3, 2020.
The subject of the meeting is to consider and act on the following:
1. Public Comments
2. Approve Minutes of May 6, 2020 Board of Directors Meeting
3. Tax Assessor/Collector's Report; invoices and checks; delinquent tax collection; installment payment requests; write-off of uncollectible accounts; investment of District funds; waiver requests; Depository Pledge Agreements
4. Bookkeeper’s Report; pay bills; checks and invoices; investment of District funds; budget; Depository Pledge Agreements
5. Review Ethics Letter and Update by Investment Officer
6. Operator's Report; operations, maintenance and repair of District facilities; water well permit; customer appeals; termination of service; water conservation and drought contingency matters; update of capital improvements plan
7. Annual Submission of Emergency Operations Information; Application for Critical Load Status
8. Temporary policies and procedures with regard to assessment of penalties, late notice fees, and termination of water service during pendency of COVID-19 disaster declaration
9. Correspondence from Subsidence District regarding COVID-19 and WaterWise program
10. Engineer's Report; design and acceptance of facilities; advertisement for bids; construction contract(s), pay estimates and change orders; permit matters; proposal(s); utility commitments; requests for service; requests for out-of-District service and/or annexation; easements; consents to encroachment
11. Report of PJPA; waste discharge permit; operation, maintenance, repair or capital improvements to PJPA plant and facilities
12. Review Code of Ethics and director questionnaire for conflicts disclosure statement
13. Pending Business
Lori G. Aylett, Attorney for the District
000001
91275-002 476034v1 Page 2 of 2
Instructions for accessing telephone conference call:
On March 16, 2020, in accordance with section 418.016 of the Texas Government Code, Governor Abbott has suspended various provisions of the Texas Open Meetings Act that require government officials and members of the public to be physically present at a specified meeting location (the “Order”). In accordance with the Order, the District has implemented procedures to allow members of the public to participate and address the Board of Directors during the telephone conference meeting. To participate in the telephone conference meeting:
1. Please call 1-866-773-8424 and use access Code 625103# to access the meeting and announce your name to the meeting host.
2. The agenda packet is available at the following web site:
https://2618compliance.wordpress.com/board-meeting-packets/
3. The audio of the meeting will be recorded.
000002
000003
000004
000005
000006
000007
000008
000009
000010
000011
000012
Meeting Date: June 3rd
M. Marlon Ivy & Associates, Inc.
Harris County M.U.D. No 275
Operations ReportMay 2020
000013
Connections May. 15, 2020 Apr. 16, 2020 Jan. 15, 2020
Occupied Single Family 0 0 0
Vacant 0 0 0
Multi-Family 1 1 1
Commercial 42 42 42
Builder 0 0 0
Irrigation 11 11 11
Rental Meters 0 0 0
District Meters 3 3 3
Total Connections 57 57 57
Harris County Municipal Utility District No. 275Connection Report
May 2020
000014
Last Month's Receivables $21,097.34
Collections:
Penalty $50.74Water $2,906.59Sewer $6,613.40Surface Water Assessment $10,042.00Grease Trap $681.24Security Deposits $0.00Grease Trap Re-Inspection $0.00Turn On Charge $0.00Misc. $0.00Water Tap $171,540.00Customer Service Inspection $200.00Pre/Post Inspection $100.00Sewer Inspection $50.00Backflow Inspection $275.00New Account Fee $0.00Delinquent Letter Fee $0.00Returned Check Fee $0.00Overpayment $123.20
Total $192,582.17 -$192,582.17
Applied Deposits $0.00$0.00$0.00
$192,582.17
Current Billing:
Penalty $237.05Water $3,078.00Sewer $7,030.00Surface Water Assessment $9,090.20Grease Trap $870.00Misc. $0.00Adjustment $0.00
$20,305.25
This Month's Adjustment:
Penalty $30.00Water $0.00Sewer $0.00NHCRWA fee (Surface Water) $0.00Grease Trap -$30.00Security Deposits $0.00Turn On Charge $0.00Water Tap $171,540.00Customer Service Inspection $200.00Sewer Inspection $50.00Pre & Post Inspection $100.00Backflow Inspection $275.00New Account Fee $0.00Delinquent Letter Fee $0.00Returned Check Fees $0.00
$172,165.00
Current Receivables $20,985.42
Arrears Break Down:30 days arrears $1,899.9960 days arrears $88.8290 days arrears $0.00
Billed Accounts: 55Billed Consumption (gal): 2,117,000
Total Bank Deposits:
Total Current Billing
Total Adjustments
HARRIS COUNTY MUD 275
BILLING AND COLLECTIONS REPORT
April 16, 2020 through May 15, 2020
Returned ChecksRefund of Overpayment
000015
March 25, 2020 - April 25, 2020
Produced from Well 0.063 MGPurchased from NHCRWA 2.057 MGPurchased from Bilma 0.000 MG
Total Water Produced 2.120 MG
HC MUD 275 2.117 MGSold to Bilma 0.000 MG
Total Billed 2.117 MG
Accounted For Flushing 0.000 MGPercent Accounted For 99.86 %Daily Average Pumpage 0.071 MG
Harris County Municipal Utility District No. 275Water Production & Sales
Meter Read Dates
Water Production:
Water Billed:
Accountability
000016
Produced (MG)Purchased
NHCRWA (MG)Purchased Blima
PUD (MG)Billed (MG)
Sold Bilma PUD
(MG)
Accounted For/Flushing
(MG)Accountability % Four Month Average
11/25/18 - 12/26/18 0.000 2.828 0.000 2.797 0.000 98.9% 95.8%12/26/18 - 01/25/19 0.066 2.657 0.000 2.600 0.000 95.5% 96.3%01/25/19 - 02/23/19 0.000 2.787 0.000 2.671 0.000 95.8% 96.9%02/23/18 - 03/25/19 0.000 2.766 0.000 2.263 0.300 92.7% 95.7%03/25/19 - 04/25/19 0.000 2.769 0.000 2.448 0.250 97.4% 95.4%04/25/19 - 05/25/19 0.001 3.278 0.000 3.036 0.100 95.6% 95.4%05/25/19 - 06/25/19 0.000 4.149 0.000 4.053 0.000 97.7% 95.9%06/25/19 - 07/25/19 0.054 3.496 0.000 3.441 0.000 96.9% 96.9%07/25/19 - 08/26/19 0.000 3.827 0.000 3.748 0.000 97.9% 97.0%08/26/19 - 09/25/19 0.000 3.733 0.000 3.574 0.000 95.7% 97.1%09/25/19 - 10/25/19 0.042 3.206 0.000 2.919 0.150 0.000 94.5% 96.3%10/25/19 - 11/25/19 0.050 2.836 0.000 2.728 0.000 0.000 94.5% 95.7%11/25/19 - 12/26/19 0.049 2.739 0.000 2.485 0.000 0.150 94.5% 94.8%12/26/19 - 01/25/19 0.089 2.525 0.000 2.417 0.000 0.000 92.5% 94.0%01/25/19 - 02/25/20 0.050 2.459 0.000 2.406 0.000 0.000 95.9% 94.3%02/25/20 - 03/25/20 0.050 2.289 0.000 2.333 0.000 0.000 99.7% 95.7%03/25/20 - 04/25/20 0.063 2.057 0.000 2.117 0.000 0.000 99.9% 97.0%
*On Interconnect with Bilma
Harris County Municipal Utility District No. 275Water Production and Accountability Report
Meter Read Date
60.0%
70.0%
80.0%
90.0%
100.0%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Pe
rce
nt
Water Accountability
2019
2020
1
2
3
4
5
Mill
ion
Ga
llon
s
Water Production
Produced (MG) Purchased NHCRWA (MG)
000017
Operations Charges:
Operations Charges $1,469.25
Administrative Charges $188.30
Tapping & Inspections $780.00
Sanitary Sewer $0.00
Lift Station $312.75
Water Distribution $330.00
Water Production $679.25
Emergency Response $0.00
Total Operations Charges $3,759.55
Harris County Municipal Utility District No. 275Operations Charges
May 2020
000018
Hams-Galveston Subsidence District
May 12,2020
SMITH, MURDAUGH, LITTLE & BONHAM, LLP2727 ALLEN PARKWAY, SUITE 1100HOUSTON, TX 77019
Re: HC MUD 275
Dear Sponsor,
The Subsidence District is committed to preventing subsidence and ensuring a sustainable future for our
groundwater resources within the District. Over 25 years ago, the Subsidence District started a Water
Conservation Program, educating our region on how they can make small changes in water use. This year due to
the COVID-19 pandemic, our school program has experienced some disruptions. We would like to communicate
our actions in response to this with you.
Please be advised that fully sponsored WaterWise kits are still being shipped to the schools; however, many of the
orders are experiencing a delay in delivery or have been returned to the warehouse due to school closures. We will
continue to attempt shipping all orders until the middle of May. In the event the WaterWise kits cannot be
delivered to a school we would like to give our sponsors the option to have the kits shipped to their offices, where
they could be used at a later date for a community event.
In addition, the number of schools enrolled in the Water Conservation Program has been greatly affected, leaving
many sponsorship requests unfulfilled. To address this disruption, we are offering opportunities to sponsor the
District's Water Conservation Program for this current (2019-2020) school year. For every $36.46 spent on
sponsorship of the program, the District will issue 84,000 gallons of Groundwater Series B credit.
All revenue received through sponsorships are restricted for use only within the Water Conservation Program,
which consists of: the WaterWise school program, the competitive water conservation grant program, and the
operation and maintenance of the Water My Yard program; which in cooperation with the Texas A&M AgriLife
Extension provides education on efficient outdoor water use.
Please fill out the attached form and email it to me at [email protected] indicating your preferences no later
than May 22nd, 2020. Please feel free to call me at 281-956-2190 if you have any questions. We apologize for
the inconvenience during these unprecedented times, appreciate your support in our program.
Sincerely,
Kristi Pierce
Water Conservation Education Coordinator
000019
WaterWise Program Inquiry Form
Contact Name: SMITH, MURDAUGH, LITTLE & BONHAM, LLP
Sponsor Name: HC MUD 275
Phone Number: 713-652-6500
Email Address: [email protected]
If our sponsorship request has not been fulfilled for the 2019-2020 school year, the District is authorized to:
D Invoice and ship once paid, our sponsorship request of 165 _WaterWise kits to the following
contact and address:
D Invoice and allocate once paid, our total sponsorship request of 165 , or other amount of
sponsorships, to the Subsidence District's Water Conservation Program.
D Do not allocate anyofoursponsorshipsforthe remainder of the 2019-2020 school year.
000020
000021
000022
91275-002 476872v1
DIRECTOR AND AGENT QUESTIONNAIRE FOR CONFLICTS DISCLOSURE STATEMENT
In 2005, the Texas Legislature approved changes in disclosure requirements for public officials in Texas.The requirements became effective on January 1, 2006 and were clarified and amended by the legislaturein 2007 and in 2015. Many public officials, including water district directors, agents, and employees, willnot need to file a report or take any action under the act. This questionnaire will assist you in determiningif you need to fill out a Texas Ethics Commission Form CIS, Local Government Officer ConflictsDisclosure Statement, for filing with the District. Please complete and sign this questionnaire and returnit to the attorney for the District.
Name: Trent ConnerDistrict: Harris County Municipal Utility District No. 275Office Held: Director
Definition: A “business relationship” in the questions below means a connection between two ormore parties based on the commercial activity of one of the parties but does not include the following: a)a transaction that is subject to rate or fee regulation by a federal, state or local government entity; b) atransaction conducted at a price and subject to terms available to the public; or c) a purchase or lease ofgoods or services from a person that is chartered by a state or federal agency and that is subject to regularexamination by, and reporting to, that agency.
Definition: A “family member” in the questions below includes: your mother and her spouse; yourfather and his spouse; your son and his spouse; your daughter and her spouse; your spouse; and yourspouse’s mother, father, son, and daughter.
Definition: A “family relationship” in the questions below includes: your mother and her spouse;your father and his spouse; your son and his spouse; your daughter and her spouse; your grandmother andher spouse; your grandfather and his spouse; your brother and his spouse; your sister and her spouse; yourgrandson; your granddaughter; your aunt; your uncle; your niece; your nephew; your great-grandson;your great-granddaughter; your great-grandmother; your great-grandfather; your spouse; your spouse’smother; your spouse’s father; your spouse’s son; your spouse’s daughter; your spouse’s grandmother;your spouse’s grandfather; your spouse’s grandson; your spouse’s granddaughter; your spouse’s brother;or your spouse’s sister.
Definition: A “vendor” in the questions below includes anyone who contracts with the District forthe sale or purchase of real property, goods, personal property, or services (skilled or unskilled labor orprofessional services) or anyone who SEEKS to contract with the District. Agents and employees of thevendor are included.
5. Do you or any Family Member have an employment relationship with any Vendor orpotential Vendor that could result in you or your Family Member receiving taxableincome (other than investment income) of more than $2,500?
Yes No
6. Do you or any Family Member have a Business Relationship with any Vendor orpotential Vendor that could result in you or your Family Member receiving taxableincome (other than investment income) of more than $2,500?
Yes No
000023
91275-002 476872v1
7. Has a Vendor or potential Vendor given you or any Family Member one or more gifts(not including food accepted as a guest or a political contribution) with a total value ofmore than $100?
Yes No
8. Does any Vendor or potential Vendor have a Family Relationship with you?
Yes No
If the answer to any of your questions is yes, please notify the attorney for the District as soon as possible.You may need to complete a Conflicts Disclosure Statement for filing with the District.
If your answer to any of these questions changes at any time in the future, please notify the attorney forthe District at once and update this form.
By:Trent Conner
Date signed:
Please note, Form CIS (attached) need only becompleted if you answered YES to any questions onthis “Director Questionnaire for Conflicts DisclosureStatement.”
000024
91275-002 476872v1
3
1
2
4
LOCAL GOVERNMENT OFFICER
CONFLICTS DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.)
This questionnaire reflects changes made to the law by H.B. 23, 84th
Leg., Regular Session.
This is the notice to the appropriate local governmental entity that the following local
government officer has become aware of facts that require the officer to file this statement in
accordance with Chapter 176, Local Government Code.
Name of Local Government Officer
Office Held
Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code
Description of the nature and extent of each employment or other business relationship and each family
relationship with vendor named in item 3.
List gifts accepted by the local government officer and any family member, if aggregate value of the gifts acceptedfrom vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B).
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
AFFIDAVIT
Signature of Local Government OfficerAFFI X NOTA RY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said , this the day
of , 20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015
FORM CIS
OFFICE USE ONLY
HCMUD 275
5
6I swear under penalty of perjury that the above statement is true and correct. I acknowledgethat the disclosure applies to each family member (as defined by Section 176.001(2), LocalGovernment Code) of this local government officer. I also acknowledge that this statementcovers the 12-month period described by Section 176.003(a)(2)(B), Local Government Code.
000025
91275-002 476872v1
LOCAL GOVERNMENT OFFICER CONFLICTS DISCLOSURE STATEMENT
Section 176.003 of the Local Government Code requires certain local government officers to file this form. A "local government officer" is
defined as a member of the governing body of a local governmental entity; a director, superintendent, administrator, president, or other
person designated as the executive officer of a local governmental entity; or an agent of a local governmental entity who exercises discretion
in the planning, recommending, selecting, or contracting of a vendor. This form is required to be filed with the records administrator of the
local governmental entity not later than 5 p.m. on the seventh business day after the date on which the officer becomes aware of the facts
that require the filing of this statement.
A local government officer commits an offense if the officer knowingly violates Section 176.003, Local Government Code. An
offense under this section is a misdemeanor.
Refer to chapter 176 of the Local Government Code for detailed information regarding the requirement to file this form.
INSTRUCTIONS FOR COMPLETING THIS FORM
The following numbers correspond to the numbered boxes on the other side.
7. Name of Local Government Officer. Enter the name of the local government officer filing this statement.
8. Office Held. Enter the name of the office held by the local government officer filing this statement.
9. Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code. Enter the name of the
vendor described by Section 176.001(7), Local Government Code, if the vendor: a) has an employment or other business
relationship with the local government officer or a family member of the officer as described by Section 176.003(a)(2)(A), Local
Government Code; b) has given to the local government officer or a family member of the officer one or more gifts as described
by Section 176.003(a)(2)(B), Local Government Code; or c) has a family relationship with the local government officer as defined
by Section 176.001(2-a), Local Government Code.
10. Description of the nature and extent of each employment or other business relationship and each family
relationship with vendor named in item 3. Describe the nature and extent of the employment or other business relationship the
vendor has with the local government officer or a family member of the officer as described by Section 176.003(a)(2)(A), Local
Government Code, and each family relationship the vendor has with the local government officer as defined by Section
176.001(2-a), Local Government Code.
11. List gifts accepted, if the aggregate value of the gifts accepted from vendor named in item 3 exceeds $100. List
gifts accepted during the 12-month period (described by Section 176.003(a)(2)(B), Local Government Code) by the local
government officer or family member of the officer from the vendor named in item 3 that in the aggregate exceed $100 in value.
12. Affidavit. Signature of local government officer.
Local Government Code § 176.001(2-a): “Family relationship” means a relationship between a person and another person
within the third degree by consanguinity or the second degree by affinity, as those terms are defined by Subchapter B, Chapter
573, Government Code.
Local Government Code § 176.003(a)(2)(A):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(2) the vendor:
(A) has an employment or other business relationship with the local government officer or a family
member of the officer that results in the officer or family member receiving taxable income, other
than investment income, that exceeds $2,500 during the 12-month period preceding the date that
the officer becomes aware that:
(iii)a contract between the local governmental entity and vendor has been executed; or
(iv) the local governmental entity is considering entering into a contract with the vendor.
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015
000026
91275-002 476872v1
DIRECTOR AND AGENT QUESTIONNAIRE FOR CONFLICTS DISCLOSURE STATEMENT
In 2005, the Texas Legislature approved changes in disclosure requirements for public officials in Texas.The requirements became effective on January 1, 2006 and were clarified and amended by the legislaturein 2007 and in 2015. Many public officials, including water district directors, agents, and employees, willnot need to file a report or take any action under the act. This questionnaire will assist you in determiningif you need to fill out a Texas Ethics Commission Form CIS, Local Government Officer ConflictsDisclosure Statement, for filing with the District. Please complete and sign this questionnaire and returnit to the attorney for the District.
Name: Gary WallaceDistrict: Harris County Municipal Utility District No. 275Office Held: Director
Definition: A “business relationship” in the questions below means a connection between two ormore parties based on the commercial activity of one of the parties but does not include the following: a)a transaction that is subject to rate or fee regulation by a federal, state or local government entity; b) atransaction conducted at a price and subject to terms available to the public; or c) a purchase or lease ofgoods or services from a person that is chartered by a state or federal agency and that is subject to regularexamination by, and reporting to, that agency.
Definition: A “family member” in the questions below includes: your mother and her spouse; yourfather and his spouse; your son and his spouse; your daughter and her spouse; your spouse; and yourspouse’s mother, father, son, and daughter.
Definition: A “family relationship” in the questions below includes: your mother and her spouse;your father and his spouse; your son and his spouse; your daughter and her spouse; your grandmother andher spouse; your grandfather and his spouse; your brother and his spouse; your sister and her spouse; yourgrandson; your granddaughter; your aunt; your uncle; your niece; your nephew; your great-grandson;your great-granddaughter; your great-grandmother; your great-grandfather; your spouse; your spouse’smother; your spouse’s father; your spouse’s son; your spouse’s daughter; your spouse’s grandmother;your spouse’s grandfather; your spouse’s grandson; your spouse’s granddaughter; your spouse’s brother;or your spouse’s sister.
Definition: A “vendor” in the questions below includes anyone who contracts with the District forthe sale or purchase of real property, goods, personal property, or services (skilled or unskilled labor orprofessional services) or anyone who SEEKS to contract with the District. Agents and employees of thevendor are included.
9. Do you or any Family Member have an employment relationship with any Vendor orpotential Vendor that could result in you or your Family Member receiving taxableincome (other than investment income) of more than $2,500?
Yes No
10. Do you or any Family Member have a Business Relationship with any Vendor orpotential Vendor that could result in you or your Family Member receiving taxableincome (other than investment income) of more than $2,500?
Yes No
000027
91275-002 476872v1
11. Has a Vendor or potential Vendor given you or any Family Member one or more gifts(not including food accepted as a guest or a political contribution) with a total value ofmore than $100?
Yes No
12. Does any Vendor or potential Vendor have a Family Relationship with you?
Yes No
If the answer to any of your questions is yes, please notify the attorney for the District as soon as possible.You may need to complete a Conflicts Disclosure Statement for filing with the District.
If your answer to any of these questions changes at any time in the future, please notify the attorney forthe District at once and update this form.
By:Gary Wallace
Date signed:
Please note, Form CIS (attached) need only becompleted if you answered YES to any questions onthis “Director Questionnaire for Conflicts DisclosureStatement.”
000028
91275-002 476872v1
3
1
2
4
LOCAL GOVERNMENT OFFICER
CONFLICTS DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.)
This questionnaire reflects changes made to the law by H.B. 23, 84th
Leg., Regular Session.
This is the notice to the appropriate local governmental entity that the following local
government officer has become aware of facts that require the officer to file this statement in
accordance with Chapter 176, Local Government Code.
Name of Local Government Officer
Office Held
Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code
Description of the nature and extent of each employment or other business relationship and each family
relationship with vendor named in item 3.
List gifts accepted by the local government officer and any family member, if aggregate value of the gifts acceptedfrom vendor named in item 3 exceeds $100 during the 12-month period described by Section 176.003(a)(2)(B).
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
Date Gift Accepted Description of Gift
(attach additional forms as necessary)
AFFIDAVIT
Signature of Local Government OfficerAFFI X NOTA RY STAMP / SEAL ABOVE
Sworn to and subscribed before me, by the said , this the day
of , 20 , to certify which, witness my hand and seal of office.
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015
FORM CIS
OFFICE USE ONLY
HCMUD 275
5
6I swear under penalty of perjury that the above statement is true and correct. I acknowledgethat the disclosure applies to each family member (as defined by Section 176.001(2), LocalGovernment Code) of this local government officer. I also acknowledge that this statementcovers the 12-month period described by Section 176.003(a)(2)(B), Local Government Code.
000029
91275-002 476872v1
LOCAL GOVERNMENT OFFICER CONFLICTS DISCLOSURE STATEMENT
Section 176.003 of the Local Government Code requires certain local government officers to file this form. A "local government officer" is
defined as a member of the governing body of a local governmental entity; a director, superintendent, administrator, president, or other
person designated as the executive officer of a local governmental entity; or an agent of a local governmental entity who exercises discretion
in the planning, recommending, selecting, or contracting of a vendor. This form is required to be filed with the records administrator of the
local governmental entity not later than 5 p.m. on the seventh business day after the date on which the officer becomes aware of the facts
that require the filing of this statement.
A local government officer commits an offense if the officer knowingly violates Section 176.003, Local Government Code. An
offense under this section is a misdemeanor.
Refer to chapter 176 of the Local Government Code for detailed information regarding the requirement to file this form.
INSTRUCTIONS FOR COMPLETING THIS FORM
The following numbers correspond to the numbered boxes on the other side.
13. Name of Local Government Officer. Enter the name of the local government officer filing this statement.
14. Office Held. Enter the name of the office held by the local government officer filing this statement.
15. Name of vendor described by Sections 176.001(7) and 176.003(a), Local Government Code. Enter the name of the
vendor described by Section 176.001(7), Local Government Code, if the vendor: a) has an employment or other business
relationship with the local government officer or a family member of the officer as described by Section 176.003(a)(2)(A), Local
Government Code; b) has given to the local government officer or a family member of the officer one or more gifts as described
by Section 176.003(a)(2)(B), Local Government Code; or c) has a family relationship with the local government officer as defined
by Section 176.001(2-a), Local Government Code.
16. Description of the nature and extent of each employment or other business relationship and each family
relationship with vendor named in item 3. Describe the nature and extent of the employment or other business relationship the
vendor has with the local government officer or a family member of the officer as described by Section 176.003(a)(2)(A), Local
Government Code, and each family relationship the vendor has with the local government officer as defined by Section
176.001(2-a), Local Government Code.
17. List gifts accepted, if the aggregate value of the gifts accepted from vendor named in item 3 exceeds $100. List
gifts accepted during the 12-month period (described by Section 176.003(a)(2)(B), Local Government Code) by the local
government officer or family member of the officer from the vendor named in item 3 that in the aggregate exceed $100 in value.
18. Affidavit. Signature of local government officer.
Local Government Code § 176.001(2-a): “Family relationship” means a relationship between a person and another person
within the third degree by consanguinity or the second degree by affinity, as those terms are defined by Subchapter B, Chapter
573, Government Code.
Local Government Code § 176.003(a)(2)(A):
(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:
(2) the vendor:
(A) has an employment or other business relationship with the local government officer or a family
member of the officer that results in the officer or family member receiving taxable income, other
than investment income, that exceeds $2,500 during the 12-month period preceding the date that
the officer becomes aware that:
(v) a contract between the local governmental entity and vendor has been executed; or
(vi) the local governmental entity is considering entering into a contract with the vendor.
Form provided by Texas Ethics Commission www.ethics.state.tx.us Revised 11/30/2015
000030
000031
000032
DIRECTOR AND AGENT QUESTIONNAIRE FOR CONFLICTS DISCLOSURE STATEMENT
In 2005, the Texas Legislature approved changes in disclosure requirements for public officials in Texas.
The requirements became effective on January 1, 2006 and were clarified and amended by the legislaturein 2007 and in 2015. Many public officials, including water district directors, agents, and employees, will
not need to file a report or take any action under the act. This questionnaire will assist you in determiningif you need to fill out a Texas Ethics Commission Form CIS, Local Government Officer Conflicts
Disclosure Statement, for filing with the District. Please complete and sign this questionnaire and return
it to the attorney for the District.
Name: Nancy Speich
District: Harris County Municipal Utility District No. 275Office Held: Director
Definition: A "business relationship" in the questions below means a connection between two or
more parties based on the commercial activity of one of the parties but does not include the following: a)
a transaction that is subject to rate or fee regulation by a federal, state or local government entity; b) a
transaction conducted at a price and subject to terms available to the public; or c) a purchase or lease of
goods or services from a person that is chartered by a state or federal agency and that is subject to regular
examination by, and reporting to, that agency.
Definition: A "family member" in the questions below includes: your mother and her spouse; your
father and his spouse; your son and his spouse; your daughter and her spouse; your spouse; and yourspouse's mother, father, son, and daughter.
Definition: A "family relationship" in the questions below includes: your mother and her spouse;
your father and his spouse; your son and his spouse; your daughter and her spouse; your grandmother and
her spouse; your grandfather and his spouse; your brother and his spouse; your sister and her spouse; your
grandson; your granddaughter; your aunt; your uncle; your niece; your nephew; your great-grandson;
your great-granddaughter; your great-grandmother; your great-grandfather; your spouse; your spouse's
mother; your spouse's father; your spouse's son; your spouse's daughter; your spouse's grandmother;your spouse's grandfather; your spouse's grandson; your spouse's granddaughter; your spouse's brother;or your spouse's sister.
Definition: A "vendor" in the questions below includes anyone who contracts with the District for
the sale or purchase of real property, goods, personal property, or services (skilled or unskilled labor orprofessional services) or anyone who SEEKS to contract with the District. Agents and employees of the
vendor are included.
1. Do you or any Family Member have an employment relationship with any Vendor or
potential Vendor that could result in you or your Family Member receiving taxable
income (other than investment income) of more than $2,500?
_Yes A No
2. Do you or any Family Member have a Business Relationship with any Vendor or
potential Vendor that could result in you or your Family Member receiving taxable
income (other than investment income) of more than $2,500?
_Yes ^ No
91275-002 474282vl
000033
3. Has a Vendor or potential Vendor given you or any Family Member one or more gifts
(not including food accepted as a guest or a political contribution) with a total value ofmore than $100?
Yes A No}C4. Does any Vendor or potential Vendor have a Family Relationship with you?
_Yes __2___NoT
If the answer to any of your questions is yes, please notify the attorney for the District as soon as possible.You may need to complete a Conflicts Disclosure Statement for filing with the District.
If your answer to any of these questions changes at any time in the future, please notify the attorney forthe District at once and update this form.
By:. <%^^ ^ ^^^c^Date signed: ^72ff / ^- 0 ^ &7—T
Please note. Form CIS (attached) need only becompleted if you answered YES to any questions onthis "Director Questionnaire for Conflicts DisclosureStatement."
91275-002 474282vl
000034
PLEASE CHECK THIS SITE OFTEN,
AS ITEMS MAY BE ADDED TO
THE PACKET UNTIL THE START
TIME OF THE TELEPHONIC
MEETING.
000035