Conflict_of_Interest_Form.pdf
PDF 143 KB Posted
- Attached to
- 123 N. H Street EV Charger Parking Lot Project
- Solicitation number
- 2026-ITB-002DW
- Issued by
- Santa Barbara County, Los Angeles City, California
About this file
This is a Conflict-of-Interest Declaration Form from the City of Lompoc Purchasing Department for the 123 N. H Street EV Charger Parking Lot Project in California. The form requires all participants in the solicitation and selection processes to declare that they have no financial, personal, or other interests that could constitute a conflict of interest regarding 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 could compromise impartiality, and commit to disclosing any potential conflicts of interest that may arise in the future. The declaration requires a wet signature (original document) and can be submitted via fax or scan. Bids for the EV Charger Parking Lot Project are due by 2:00 pm on Thursday, January 29, 2026, with proposals valid for 90 calendar days after the bid opening date.
The project scope includes grading and paving improvements, concrete walkways, curbing, ADA-accessible parking upgrades, EV charging station and bollard installation, landscaping, signage, pavement markings, and electrical coordination for conduit placement and power connections. The City of Lompoc is seeking a qualified contractor to deliver high-quality work while coordinating with City staff and utility partners. Per City Ordinance 3.36.080, no City employee may participate in the solicitation or selection process if they have a relationship with a vendor or proposer that would subject them to the prohibitions of California Government Code sections 87100 or 1090 or any other applicable law or the City's Conflict of Interest Code.
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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) mailto:purchasing@ci.lompoc.ca.us
File details come from the government source that posted it. Updated .