Conflict_of_Interest_Form.pdf
PDF 184 KB Posted
- Attached to
- RYON PARK STAGE AREA IMPROVEMENT PROJECT
- Solicitation number
- ITB NO. 3113
- Issued by
- Santa Barbara County, Los Angeles City, California
About this file
This is a No Conflict-of-Interest Declaration Form issued by the City of Lompoc, California Purchasing Department for the Ryon Park Stage Area Improvement Project. The form requires employees and personnel involved in the solicitation or selection process to declare that they have no financial, personal, or other interests that could compromise their impartiality or violate Government Code sections 87100 and 1090. Signatories must confirm they have no direct or indirect financial interests in vendors or proposers, no personal relationships or affiliations that could compromise objectivity, and agree to disclose any potential conflicts of interest that may arise in the future. The City of Lompoc is soliciting bids for the Ryon Park Stage Area Improvement Project with bid submissions due by 2:00 pm on Thursday, July 2, 2026, with proposals valid for 90 calendar days after the bid opening date.
The form requires a wet signature (original) and allows submission by fax or scan. All personnel completing the declaration must fill in highlighted areas including name, date, position/title, and department/organization, then sign on the unhighlighted signature line. The declaration serves as a compliance mechanism under City of Lompoc Municipal Code Section 3.36.080, which prohibits any city employee from participating in procurement solicitation or selection processes when they have relationships with vendors or proposers that would subject them to applicable state law restrictions or the City's Conflict of Interest Code.
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Text version
No Conflict-of-Interest Declaration Form
Name: ________________________________ Date: ________________________________ Position/Title: _________________________ Department/Organization: _____________________________________ 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
I, 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.
Date:Signature: __________ 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)
City of Lompoc, Purchasing Department 100 Civic Center Plaza, Lompoc, CA 93436 (805)875-8000 fax (805)875-8633 purchasing@ci.lompoc.ca.us mailto:purchasing@ci.lompoc.ca.us
| Name: ________________________________ |
| Date: ________________________________ |
| Signature: _______________ Date: __________ |
| § 3.36.080Conflict of Interest. |
| Date: |
| PositionTitle: |
| Date_2: |
| Full Name: |
| Full Name 2: |
| Organization Name: |
| Department / Organization: |
File details come from the government source that posted it. Updated .