Conflict_of_Interest_Form.pdf
PDF 184 KB Posted
- Attached to
- Lompoc Library HVAC Units Replacement Project
- Solicitation number
- RFP NO. 3077
- 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 for use in procurement processes. The form requires employees and officials involved in solicitation and selection activities to affirm that they have no financial, personal, or other interests that could create conflicts of interest in relation to their professional duties. Signatories must confirm they have no direct or indirect financial interests in entities or individuals that could influence their decisions, no personal relationships or affiliations that would compromise impartiality, and commit to disclosing any potential conflicts that may arise during the procurement process. The form is applicable to the Lompoc Library HVAC Units Replacement Project, with bids due by 2:00 pm on Friday, September 4, 2026, and proposals valid for 90 calendar days after the bid opening date. Only authorized City contacts, specifically the Purchasing Officer or designated staff, are permitted to communicate with bidders regarding the solicitation; unauthorized communications may result in bid rejection.
The form must be completed with original wet signatures and submitted by all parties participating in the procurement process. The City of Lompoc Purchasing Department, located at 100 Civic Center Plaza, Lompoc, CA 93436, enforces compliance with Government Code sections 87100 and 1090, as well as the City's Conflict of Interest Code, to ensure impartial and ethical procurement practices. All interested bidders must register as "Registered Bidders" and may submit written questions to Theresa Hernandez, Senior Buyer, by 4:00 pm on August 27, 2026.
View the file
Other files
Show all 24
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .