Conflict_of_Interest_Form.cleaned.pdf

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Attached to
LIME SLAKER REPLACEMENT PROJECT
Solicitation number
RFQ/P NO. 3095
Issued by
Santa Barbara County, Los Angeles City, California

About this file

This is a Conflict-of-Interest Declaration Form issued by the City of Lompoc, California Purchasing Department in conjunction with the Lime Slaker Replacement Project (RFQ/RFP No. 3095) at the City's Water Treatment Plant. The project seeks qualified consulting firms to provide preliminary design services and prepare proposal documents for the upgrade of two existing lime slaker units serving approximately 10 million gallons per day for the City's 43,000 residents. A non-mandatory pre-proposal meeting and site visit is scheduled for Monday, April 13, 2026, at 10:00 a.m., with written inquiries due by Tuesday, April 21, 2026, at 4:00 p.m. Proposals are due by 2:00 p.m. on Thursday, April 30, 2026, and must be submitted in one original with original signatures, three hard copies, one thumb drive, and via the OpenGov platform. The selected consultant will provide services throughout the preliminary design, proposal, and construction phases over an initial three-year contract term with options for two additional one-year renewal periods. Proposals will be evaluated on five criteria: Project Understanding and Approach (30 points), Team Qualifications (25 points), Project Schedule (20 points), Responsiveness to RFQ (20 points), and Local Presence (5 points), with the top three ranked firms selected for interviews before fee negotiations commence with the highest-ranked firm.

All proposers must maintain professional liability insurance with minimum limits of $2,000,000 per occurrence for Commercial General Liability and $1,000,000 per occurrence for Automobile Liability, comply with California Labor Code prevailing wage requirements, and hold a valid Business Tax License with the City of Lompoc. Labor estimates must be broken down by hours and task using hourly billing rates with standard billing rate sheets, with total compensation not to exceed an amount to be determined in Exhibit B of the final Professional Services Agreement. The project is funded by the Water Lime Slaker Account and subject to state and federal regulations, with payment processed within 45 days of invoice presentation. The pre-design report evaluated three technology options with estimated costs ranging from $1,075,252 to $1,520,000, with the Chemco detention slaker recommended based on technical suitability and cost-effectiveness. Proposals must remain valid for 90 calendar days after the bid opening date, and all communication regarding the solicitation must be directed exclusively to Theresa Hernandez, Senior Buyer at the City of Lompoc Purchasing Division. The Conflict-of-Interest Declaration Form requires that all City employees participating in the solicitation or selection processes certify they have no financial, personal, or other interests that could create conflicts under Government Code sections 87100 or 1090, with wet signatures required on original forms.

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Text version

No Conflict-of-Interest Declaration Form

City of Lompoc, Purchasing Department, 100 Civic Center Plaza, Lompoc, CA 93436 (805)875-8000 fax (805)875-8633 purchasing@ci.lompoc.ca.us

Name: [Your Full Name] Date: [Insert Date]

Position/Title: [Your Job Title]

Department/Organization: [Your Department/ Organization Name]

I, [Your Full Name], hereby declare that I have no financial, personal, or other interests that could be perceived as a conflict of interest in relation to my professional duties and responsibilities at [Your Organization Name].

I confirm that:

1. I do not have any direct or indirect financial interests in any entities or individuals that could influence my decisions or actions.

2. I do not have any personal relationships or affiliations that could compromise my impartiality.

3. I will disclose any potential conflicts of interest that may arise in the future.

By signing this declaration, I affirm that the information provided is true and accurate to the best of my knowledge.

Signature: ___________________________ Date: _______________________________

Note: Wet signature required (Original) can be faxed or scanned by all parties Fill in highlighted areas and then sign on unhighlighted line.

§ 3.36.080Conflict of Interest.

No City employee shall participate in the solicitation or selection processes for any procurement of any kind when that employee has a relationship with a vendor or proposer which would subject that employee to the prohibition of Government Code section 87100 or 1090 or any other applicable provision of law or the City's Conflict of

Interest Code.

(Prior code § 2633; Ord. 1637(17) § 1)

File details come from the government source that posted it. Updated .