Attachment A
UNIVERSITY OF HOUSTON-VICTORIA
Related Party
Disclosure Form
A Related Party Disclosure is a question of fact that results when an individual is in a position to personally benefit from transactions entered into by the University of Houston-Victoria or other System component. Transactions include, but are not limited to originating purchase requisitions, influencing purchasing decisions, and consulting or professional relationships.
Policy
Employees of the
University of Houston-Victoria shall avoid using their positions for purposes
that are, or give the appearance of being, motivated by a desire for private
gain for themselves or others, such as those with whom they have family,
business, or other ties. University employees shall exercise the utmost
good faith in all transactions, activities, and behaviors related to their
duties to the UH System, its property, and resources. Faculty and staff in
a position to personally benefit from a transaction entered into by the
University of Houston-Victoria or other UHS components shall annually complete a
disclosure statement regarding related party interests as required by UHS Administrative
Memorandum 02.A.10.
Related Party
Disclosures are to be completed annually by all faculty and staff employees
within any of the following categories:
(a) employees who have previously disclosed a
related party interest;
(b) employees who serve in a supervisory
capacity at a department level or higher;
(c) employees in a
position to make final purchasing decisions. This category includes all
delegated departmental purchasers and ProCard users;
(d) employees having
signature authority on any university cost center;
(e) employees who could
personally benefit from a relationship or business
transaction.
Confirmation
and Disclosure Statement
I have
read the University of Houston System Administrative Memorandum 02.A.10 and the
University of Houston-Victoria policy, E-7, regarding disclosure of
related-party interests and understand my responsibility to disclose such
activities and relationships. Except as described below, to the best of my
knowledge, within the past year neither I nor any close member of my family have
had any related party transactions or relationships. In addition, except as
described below, I am not involved in or aware of the involvement of other
faculty or staff in any activities or organization which are related-party
transactions or relationships.