2016-04-26 SLAC PacketCity of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
M E M O R A N D U M
April 21, 2016
TO: Southlake Arts Council
FROM: Cassie Tucker, Assistant to the Director of Community Services
SUBJECT: Agenda Item Comments for the Southlake Arts Council meeting
– Tuesday, April 26, 2016
The meeting will be held in Town Hall 4th Floor Room 4A, at 6:00 p.m.
If you are not able to attend this meeting, please notify staff at 817.748.8184 or
lcarpenter@ci.southlake.tx.us.
1. Agenda Item No. 2A. Consent: Approval of the minutes from the Southlake Arts
Council meeting held March 22, 2016. Please make any corrections to the minutes
part of the motion for consideration.
2. Agenda Item No. 3A. Consider: Southlake Arts Council recommendation to approve
the concept provided by artist Mark White to provide Public Art to be installed at
Frank Edgar Cornish, IV Park – At the March 22, 2016 Arts Council meeting, options
for moving forward with selection of an art piece for Frank Cornish Park were
presented. The options were for the Arts Council to either make a recommendation
for one artist to provide a concept for Public Art at Frank Edgar Cornish, IV Park; or,
make a recommendation to re-release a new Call to Artist, with updated language
specifically requesting kinetic proposals. The Southlake Arts Council agreed to seek
a concept from one artist, Mark White, for the kinetic art piece for the Park. The
alternate artist selected was Lyman Whitaker. Copies of Mr. White’s concept and
sample construction materials for the piece will be presented for your
recommendation at the meeting.
Funding in the amount of $75,000 for the design and installation of artwork is
approved in FY 2016 Public Art budget for Phase I of the Public Sculpture Program.
The artist for the commissioned art will be granted a $500 stipend to complete model
of their final concept.
3. Agenda Item No. 4A. Discussion: Strokes of Art in the Square Reception Wrap Up –
The purpose of this item is to allow the Southlake Arts Council to recap the art
exhibit on display February 22, 2016 – April 24, 2016 in Town Hall in conjunction
with the Art In The Square festival. There are no packet documents for this item.
Southlake Arts Council
Meeting Date – April 26, 2016
Page 2 of 3
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
4. Agenda Item No. 4B. Discussion: Apex Film Day – Plans for the Apex Film Day to be
held May 7, 2016 may be discussed at this time. There are no packet documents for
this item.
5. Agenda Item No. 4C. Discussion: Fort Worth Symphony Orchestra Opportunities –
Opportunities for partnership with the Fort Worth Symphony Orchestra may be
discussed at this time. There are no packet documents for this item.
6. Agenda Item No. 4D. Discussion: September 2016 Art Gallery Event – The purpose
of this item is to allow Southlake Arts Council an opportunity to brainstorm and plan
the annual art gallery event for September 2016. There are no packet documents for
this item.
7. Agenda Item No 4E. Discussion: Project Update – Staff will provide an update on the
Kathleen Caricof piece to be installed at The Marq Southlake, and the Dream Big
piece to be installed at the Dove/Peytonville/Sam School Road roundabout. There
are no packet documents for this item.
8. Agenda Item No. 4F. Discussion: Fiscal Year 2017 Projects – This item will allow
Southlake Arts Council and staff to discuss opportunities for public art and cultural
activities for FY2017. There are no packet documents for this item.
9. Agenda Item No. 4G. Discussion: Local Government Officer Conflicts Disclosure
Statement – The City Secretary’s Office has requested all City-appointed board,
commission and committee members be informed of requirements regarding
disclosure of relationships with existing City vendors.
In accordance with Texas Local Government Code 176, a copy of the Local
Government Officer Conflicts Disclosure Statement is included in your packet to
review the requirements to determine if you have any conflicts to disclose. Please
consult the City’s Vendor List, available on the City’s website at
http://www.cityofsouthlake.com/DocumentCenter/View/11543 . If you or a family
member has employment or other business relationships as described in the
Statement with any existing City vendor, a Local Government Officer Conflicts
Disclosure Statement must be filed. By law, this Statement must be filed no later
than the seventh business day after the person (board member) becom es aware of
the facts that require the Statement to be filed. Statements are filed with the City
Secretary’s Office, 1400 Main Street, Suite 270, Southlake Texas 76092. Please
contact the City Secretary’s Office at 817.748.8183 or lpayne@ci.southlake.tx.us for
any questions regarding this matter.
10. Agenda Item No. 5. Public Forum
This is the public's opportunity to address the Arts Council about non-agenda items.
During Public Forum, the Arts Council will not discuss or take action on any item
brought up at this time.
Southlake Arts Council
Meeting Date – April 26, 2016
Page 3 of 3
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
11. For Your Information – Attendance Report – A copy of the Southlake Arts Council
attendance log is included in your packet.
We appreciate your commitment and service to the City.
CHT
STAFF CONTACT INFORMATION:
Telephone – (817) 748-8019
Facsimile – (817) 748-8027
1400 Main Street, Ste. 210, Southlake, Texas 76092
Chris Tribble, Director of Community Services (817) 748-8021; ctribble@ci.southlake.tx.us
Candice Edmondson, Deputy Director of Community Services, (817) 748-8311; cedmondson@ci.southlake.tx.us
Cassie Tucker, Assistant to Director of Community Services, (817) 748-8036; ctucker@ci.southlake.tx.us
Linda Carpenter-Elgin, Administrative Secretary, (817) 748-8184; lcarpenter@ci.southlake.tx.us
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
SOUTHLAKE ARTS COUNCIL
Tuesday, April 26, 2016
Location: Southlake Town Hall
1400 Main Street – 4th Floor (4A)
Southlake, Texas
Time: 6:00 p.m.
Agenda:
1. Call to Order
2. Consent
A. Approval of the minutes from the March 22, 2016 regular Southlake Arts Council
meeting
3. Consider
A. Southlake Arts Council recommendation to approve the concept provided by
artist Mark White to provide Public Art to be installed at Frank Edgar Corni sh, IV
Park
4. Discussion
A. Strokes of Art in the Square Exhibit Wrap Up
(February 22 through April 24, 2016)
B. Apex Film Day (May 7, 2016)
C. Fort Worth Symphony Orchestra Opportunities
D. September 2016 Art Gallery Event
E. Project Update
F. Fiscal Year 2017 Projects
G. Local Government Officer Conflicts Disclosure Statement
5. Public Forum
(This is the Public’s opportunity to address Southlake Arts Council about non-agenda items.
During Public Forum, Southlake Arts Council will not discuss, consider or take action on any
items presented. Southlake Arts Council respectfully asks anyone speaking during Public
Forum to limit remarks to three minutes or less.)
6. Adjournment
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
SOUTHLAKE ARTS COUNCIL MEETING, MARCH 22, 2016
LOCATION: The Marq Southlake – Legacy Meeting Room 1
Southlake, Texas
TIME: 6:00 p.m.
SOUTHLAKE ARTS COUNCIL PRESENT: Chair Leslie Bartlett, Vice Chair Miriam
Murray, Secretary Jesika Cook and Southlake Arts Council members Terri Messing,
Tamara McMillan, Devika Seth and Kelly Trager (Alternate 1)
SOUTHLAKE ARTS COUNCIL ABSENT: Merlene Ingraham
STAFF PRESENT: Deputy Director Candice Edmondson and Assistant to the Director
Cassie Tucker
REGULAR SESSION
1. CALL TO ORDER
The meeting was called to order by Arts Council Chairman Bartlett at 6:09 p.m.
2. CONSENT AGENDA
Consent Agenda items are considered to be routine by the Southlake Arts
Council and are enacted with one motion.
2A. APPROVAL OF THE MINUTES FROM THE FEBRUARY 9, 2016 SOUTHLAKE
ARTS COUNCIL MEETING
Minor corrections were made to the minutes of the February 9, 2016 meeting.
APPROVED
A motion was made to accept the minutes of February 9, 2016 meeting with the
corrections.
Motion: Trager (Alt #1)
Second: Cook & Murray
Ayes: Bartlett, Cook, Messing, Murray, Seth, Trager (Alt #1)
Nays: None
Abstain: None
Vote: 6-0
Motion Carried
2A -1
Minutes of the March 22, 2016 Southlake Arts Council Meeting
Page 2 of 5
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
Five (5) of the regular seven (7) member Southlake Arts Council were present for this vote. In the
absence of Southlake Arts Council members Tamara McMillan and Merlene Ingraham, Southlake
Arts Council Alternate #1, Kelly Trager, participated. An Alternate may sit as a regular member in
the event of an absence of one or more regular members per Ordinance No. 908, Section 2.
Arts Council member McMillan arrived at 6:15 p.m.
3. CONSIDER
3A. RECOMMENDATION ON ARTISTS FOR PUBLIC ART TO BE INSTALLED AT
FRANK EDGAR CORNISH, IV PARK
Assistant to the Director Cassie Tucker presented options for moving forward
with selection of an art piece for Frank Cornish Park. The options were for the
Arts Council to either make a recommendation for one artist to provide a concept
for Public Art at Frank Edgar Cornish, IV Park; or, make a recommendation to re-
release a new Call to Artist, with updated language specifically requesting kinetic
proposals. The Southlake Arts Council reviewed websites of kinetic artists,
provided feedback of their preferences, and agreed to seek a concept from one
artist, Mark White, for the kinetic art piece for the Park. The alternate artist
selected is Lyman Whitaker. Mr. White’s concept, as well as sample construction
materials for the piece, will be provided at the next meeting.
APPROVED
A motion was made to recommend artist Mark White provide an art concept for
the piece for Frank Edgar Cornish, IV Park.
Motion: Cook
Second: Trager (Alt #1)
Ayes: Bartlett, Cook, Messing, McMillan, Murray, Seth, Trager (Alt#1)
Nays: None
Abstain: None
Vote: 7-0
Motion Carried
Six (6) of the regular seven (7) member Southlake Arts Council were present for this vote. In the
absence of Southlake Arts Council member Merlene Ingraham, Southlake Arts Council Alternate
#1, Kelly Trager, participated. An Alternate may sit as a regular member in the event of an
absence of one or more regular members per Ordinance No. 908, Section 2.
3B. RECOMMENDATION TO REVISE PUBLIC ART AND/OR PERFORMANCE
POLICY
Assistant to the Director Cassie Tucker presented proposed revisions to the
Public Art and/or Performance Policy including a provision to allow the Arts
Council to be the final approver on temporary art exhibits in Town Hall. Ms.
Tucker was available to answer questions.
2A -2
Minutes of the March 22, 2016 Southlake Arts Council Meeting
Page 3 of 5
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
APPROVED
A motion was made to acknowledge the Arts Council reviewed the proposed
revisions and recommend approval of the revisions to the Public Art and/or
Performance Policy as submitted to the Arts Council.
Motion: McMillan
Second: Cook/Trager (Alt #1)
Ayes: Bartlett, Cook, Messing, McMillan, Murray, Seth, Trager (Alt #1)
Nays: None
Abstain: None
Vote: 7-0
Motion Carried
Six (6) of the regular seven (7) member Southlake Arts Council were present for this vote. In the
absence of Southlake Arts Council member Merlene Ingraham, Southlake Arts Council Alternate
#1, Kelly Trager, participated. An Alternate may sit as a regular member in the event of an
absence of one or more regular members per Ordinance No. 908, Section 2.
Arts Council member Terri Messing left the meeting at 7:35 p.m.
3C. RECOMMENDATION ON SOUTHLAKE HISTORICAL SOCIETY AVIATION
EXHIBIT PROPOSAL AND PERMIT
Assistant to the Director Cassie Tucker presented the proposal and permit from
the Southlake Historical Society to host an “Aviation in North Texas” exhibit in the
Town Hall lobby. Ms. Tucker and Deputy Director Candice Edmondson
responded to questions.
The exhibit proposal features 18 panels and 2 display cases. The panels present
a North-Texas aviation timeline that begins in 1911 and highlights aircraft
manufacturing, military, commercial and general aviation throughout the area.
Aviation memorabilia would be displayed in the display cases.
The Southlake Arts Council discussed the request and made the following
recommendations: staff and someone from the Southlake Arts Council be
present during installation of the exhibit; Southlake Historical Society be prepared
to reduce the exhibit as appropriate to the space; and exhibit dates to be after
Stars & Stripes and conclude around August 19.
APPROVED
A motion was made to recommend City Council approve the proposal and permit
to allow a Southlake Historical Society aviation exhibit in Town Hall, for the dates
of, after Stars & Stripes to around National Aviation Day on August 19, 2016.
2A -3
Minutes of the March 22, 2016 Southlake Arts Council Meeting
Page 4 of 5
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
Motion: Trager (Alt #1)
Second: Murray
Ayes: Bartlett, Cook, Murray, Seth, Trager (Alt #1)
Nays: None
Abstain: McMillan (Southlake Historical Society member)
Vote: 5-0-1
Motion Carried
Five (5) of the regular seven (7) member Southlake Arts Council were present for this vote. In the
absence of Southlake Arts Council members Merlene Ingraham and Terri Messing, Southlake
Arts Council Alternate #1, Kelly Trager, participated. An Alternate may sit as a regular member in
the event of an absence of one or more regular members per Ordinance No. 908, Section 2.
4. DISCUSSION
4A. STROKES OF ART IN THE SQUARE RECEPTION WRAP UP
Southlake Arts Council reviewed the reception held February 21, 2016 in the
Town Hall lobby.
4B. APEX FILM DAY (MAY 7, 2016)
An update on plans for the Apex Film Day to be held May 7, 2016 was
presented.
4C. FORT WORTH SYMPHONY ORCHESTRA OPPORTUNITIES
Assistant to the Director Cassie Tucker shared some information in Terri
Messing’s absence. This item will be discussed at the next meeting.
4D. SEPTEMBER 2016 ART GALLERY EVENT
Southlake Arts Council discussed featuring art work by Southlake artist Beatrice
Torres, a Pulitzer Prize winner photo journalist. Staff will check availability for the
reception on either September 7 or 8, 2016. Discussion of this item will be
continued at the next meeting.
5. PUBLIC FORUM
There was no one to speak during to Public Forum.
6. ADJOURNMENT
APPROVED
A motion was made to adjourn the meeting at 7:53 p.m.
2A -4
Minutes of the March 22, 2016 Southlake Arts Council Meeting
Page 5 of 5
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
Motion: Murray
Second: McMillan
Ayes: Bartlett, Cook, McMillan, Murray, Seth, Trager (Alt #1)
Nays: None
Abstain: None
Vote: 6-0
Five (5) of the regular seven (7) member Southlake Arts Council were present for this vote. In the
absence of Southlake Arts Council members Merlene Ingraham and Terri Messing, Southlake
Arts Council Alternate #1, Kelly Trager, participated. An Alternate may sit as a regular member in
the event of an absence of one or more regular members per Ordinance No. 908, Section 2.
Attest:
Leslie Bartlett, Chair Cassie Tucker, Assistant to Director
Community Services Department
A digital audio recording of this meeting is available in the Office of the City Secretary.
2A -5
2A -6
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
M E M O R A N D U M
April 21, 2016
To: Southlake Arts Council
From: Cassie Tucker, Assistant to the Director of Community Services
Subject: Southlake Arts Council recommendation to approve the concept
provided by artist Mark White to provide Public Art to be installed at
Frank Edgar Cornish, IV Park
Action
Requested: Southlake Arts Council recommendation to approve the concept
provided by artist Mark White to provide Public Art to be installed at
Frank Edgar Cornish, IV Park.
Background
Information: The purpose of this item is for the Arts Council to make a
recommendation to approve the concept provided by Mark White to
provide public art at Frank Edgar Cornish, IV Park, as determined
at the March 22, 2016 meeting.
Since 2009, the City has successfully commissioned several public
art projects as part of its Public Art Program, including pieces
installed at:
DPS Headquarters
Five Roundabout Intersections (four currently installed, one
scheduled to be installed in 2016)
North Park Bas Relief
Family Park – Brian Stebbins Memorial
The Marq Southlake Sculpture (scheduled to be installed in
2016)
The 2030 Public Art Master Plan recommends commissioning and
installing public art pieces throughout Town Square as a walkable
public sculpture art exhibit through some of the square’s most
vibrant retail and dining areas. Frank Edgar Cornish, IV Park has
been identified as the ideal location for the first installment of the
Public Sculpture Program.
At the February 9, 2016 Southlake Arts Council meeting, the Arts
Council reviewed 16 submittals received from the December 2015
Call to Artists for Public Art for Frank Edgar Cornish, IV park. The
3A - 1
Southlake Arts Council
Meeting Date – April 26, 2016
Page 2 of 3
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
Arts Council recommended closing the call without selection
because the submittals did not represent the type of art that fit the
concept they envision for the park.
At the March 22, 2016 Southlake Arts Council meeting, the Council
reviewed two options to select an art piece. The options were to
make a recommendation for one artist to provide a concept for the
park or to re-release a new Call to Artist specifically for kinetic
proposals. The Southlake Arts Council recommended selecting one
artist, Mark White, to provide a concept for Southlake Arts Council’s
review and recommendation. The concept will be presented at the
March 22, 2016 meeting.
The Arts Council’s recommendation on the final concept and a
personal services agreement to provide public art for Frank Edgar
Cornish, IV Park will be presented to City Council May 17, 2016.
Financial
Considerations: Funding in the amount of $75,000 for the design and installation of
artwork is approved in FY 2016 Public Art budget for Phas e 1 of the
Public Sculpture Program. Artist(s) chosen as the finalist will be
granted a $500 stipend to complete a model of their final concept.
The Call to Artists identified the maximum project budget as
$70,000. $5,000 has been set aside for expenses incurred by the
City for installation.
Strategic Link: Selection of Public Art is linked to the City’s Strategy Map related to
the focus area of Quality Development and meets the corporate
objective to provide attractive and unique spaces for the enjoyment
of personal interests. It also addresses Critical Business Outcome
CB01, to implement Southlake 2030 Plan by focusing on short-term
initiatives.
Citizen Input/
Board Review: Selection of Public Art complies with provisions of the Southlake
2030 Public Art Master Plan.
Southlake Arts Council will review the concept provided by artist
Mark White and make a recommendation to City Council.
Legal Review: Not Applicable
Alternatives: Not Applicable
3A - 2
Southlake Arts Council
Meeting Date – April 26, 2016
Page 3 of 3
City of Southlake Values:
Integrity ♦ Innovation ♦ Accountability ♦ Commitment to Excellence ♦ Teamwork
Supporting
Documents: Not Applicable
Recommendation: Southlake Arts Council recommendation to approve the concept
provided by artist Mark White to provide Public Art to be installed at
Frank Edgar Cornish, IV Park.
3A - 3
Page 1 of 3
GUIDELINES FOR FILING CONFLICTS DISCLOSURE STATEMENTS
(revised March 2016)
WHO: If required by Chapter 176 of the Texas Local Government Code, the following
municipal officers must file conflicts disclosure statements:
1. Mayors and City Council Members;
2. City Manager;
3. Board and Commission members appointed by the Mayor or City Council members,
including the Building Board of Appeals, Community Engagement Committee,
Community Enhancement and Development Corporation (CEDC), Crime Control and
Prevention District, Library Board, Parks and Recreation Board, Planning and Zoning
Commission, Senior Advisory Committee, Southlake Arts Council, Southlake Parks
Development Corporations (SPDC), Metroport Teen Court Advisory Board, and Board of
Adjustment (ZBA);
4. Directors of 4A and 4B development corporations;
5. the executive directors or managers of 4A and 4B development corporations; and
6. City employees and agents who exercise discretion in the planning, recommending,
selecting or contracting of a vendor.
WHAT: A municipal officer must sign under oath and file a conflicts disclosure statement
(Form CIS). This form is available online at www.ethics.state.tx.us and a copy is attached to this
Guideline. The form is fairly self-explanatory.
Question No. 3 of the form requires the municipal officer to disclose the name of any vendor
with which the City is contracting or considering a contract if:
1. The officer has an employment or other business relationship with the vendor, or an
employee or agent of the vendor, 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 of the contract or the consideration of a
contract;
2. The officer or a family member of the officer has received one or more gifts from the
vendor, or an agent or employee of the vendor, that have an aggregate value of more than $100
in the 12-month period preceding the date the officer becomes aware of the contract or the
consideration of a contract; or,
3. The officer has a family relationship with the vendor, or an agent or employee of the
vendor.
Question No. 4 of the form requires the officer to describe the relationship with the vendor, or an
agent or employee of the vendor, listed in Question 3.
4G - 1
Page 2 of 3
Question No. 5 of the form requires the officer to list the gifts the officer or any family member
received from a vendor, or an agent or employee of the vendor, if the aggregate value of the gifts
accepted exceeds $100 during the 12-month period preceding the date the officer becomes aware
of a contract or the consideration of a contract. Note, political contributions defined by Title 15
of the Election Code or food accepted as a guest need not be disclosed.
An Agent means a third party who undertakes to transact some business or manage some affair
for another person by the authority or on account of the other person.
A “business relationship” means a connection between two or more parties based on commercial
activity of one of the parties. The term does not include a connection based on:
1. a transaction that is subject to rate or fee regulation by a federal, state, or local
governmental entity or an agency of a federal, state, or local government entity;
2. a transaction conducted at a price and subject to terms available to the public; or
3. 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.
If a local government officer or the officer’s family member has received income as a result of
one of these types of business relationships, the officer does not have to file a conflicts disclosure
statement.
A “family member” is a person related to the municipal officer within the first degree by
consanguinity (blood) or affinity (marriage) which includes a spouse, father, mother, son,
daughter, father-in-law, mother-in-law, and son-in-law, and stepson or step daughter. It does not
include a child of a stepparent when the stepparent is divorced from the parent of the child.
A “family relationship” means a relationship between a person and another person within the
third degree by consanguinity or the second degree by affinity. See attached chart for the
relationships included within the third degree by consanguinity and the second degree by
affinity.
A “contract” includes a purchase order, or a written agreement for a sale or purchase of goods,
services, or an interest in real property.
If the income is investment income, the officer need not file a conflicts disclosure statement.
“Investment income” means dividends, capital gains, or interest income generated from:
1. a personal or business:
a. checking or savings account;
b. share draft or share account; or
c. other similar account;
2. a personal or business investment; or
4G - 2
Page 3 of 3
3. a personal or business loan.
A “Gift” is any benefit offered by a person, including food, lodging, transpo rtation, and
entertainment accepted as a guest. The term does not include a benefit offered on account of
kinship or a personal, professional or business relationship independent of the official status of
the recipient.
WHEN: The municipal officer must file the Form CIS not later than 5:00 p.m. on the seventh
business day after the date on which the officer becomes aware that a vendor has contracted with
the City or the City is considering doing business with the vendor.
WHERE: The local government officer must file the form with the City Secretary. The City
Secretary is required by law to post the form on the City's website.
ENFORCEMENT: The failure to file the required statement is a Class C misdemeanor if the
contract amount is less than $1 million or if there is no contract amount for the contract; a Class
B misdemeanor if the contract amount is at least $1 million but less than $5 million; or a Class A
misdemeanor if the contract amount is at least $5 million.
4G - 3
Revised 11/30/2015Form provided by Texas Ethics Commission www.ethics.state.tx.us
FORM CIS
Name of Local Government Officer
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.
LOCAL GOVERNMENT OFFICER
CONFLICTS DISCLOSURE STATEMENT
(Instructions for completing and filing this form are provided on the next page.)
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.
Title of officer administering oathPrinted name of officer administering oathSignature of officer administering oath
AFFIX NOTARY 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.
AFFIDAVIT
I swear under penalty of perjury that the above statement is true and correct. I acknowledge
that the disclosure applies to each family member (as defined by Section 176.001(2), Local
Government Code) of this local government officer. I also acknowledge that this statement
covers the 12-month period described by Section 176.003(a)(2)(B), Local Government Code.
Signature of Local Government Officer
Date Gift Accepted ____________ Description of Gift _________________________________________________
(attach additional forms as necessary)
List gifts accepted by the local government officer and any family member, if aggregate value of the gifts accepted
from 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 _________________________________________________
4
5
2
3
1
6
OFFICE USE ONLOFFICE USE ONLOFFICE USE ONLOFFICE USE ONLOFFICE USE ONLYYYYY
Date Received
Date Gift Accepted ____________ Description of Gift _________________________________________________
4G - 4
Revised 11/30/2015Form provided by Texas Ethics Commission www.ethics.state.tx.us
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.
1. Name of Local Government Officer. Enter the name of the local government officer filing this statement.
2. Office Held. Enter the name of the office held by the local government officer filing this statement.
3. 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.
4. 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.
5. 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.
6. 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:
(i) a contract between the local governmental entity and vendor has been executed; or
(ii) the local governmental entity is considering entering into a contract with the vendor.
4G - 5
1 Leslie Bartlett a a a 100%4 2016 84%
2 Merlene Ingraham r r r 0%0
3 Jesika Cook a a a 100%4
4 Terri Messing a a a 100%4
5 Devika Seth r a a 0%3.25
6 Miriam Murray a a a 100%4
7 Tamara McMillan a a a 100%4
Alt 1 Kelly Trager a a a 100%4
75%88%88%a In attendance
Total Hrs Per Month 0.75 1.25 2 4 r Not in attendance, no substitute
m Substitute in attendance
n Vacant position
0 Meeting Canceled
*Meeting Canceled due to no quorum
Change in Representative
Average Monthly
Attendance Rate
Meeting Attendance Rate
(includes substitutions)
9/26/16 10/24/16 11/28/16 12/26/16 Individual
Attendance Rate
Southlake Arts Council Attendance Report
Place Name 1/8/16 2/9/16 4/25/16 5/23/16 6/27/16 7/25/16 8/22/163/22/16 Hrs To
Date
Packet Insert - 2016 Southlake Arts Council Attendance