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TRCAPLEA000282.2024 City of Redwood City | FORMS <br />ROOSEVELT AVENUE PERMANENT TRAFFIC CALMING PROJECT ENGINEERING DESIGN <br />RFP #ENG24-12 <br />Local Assistance Procedures Manual EXHIBIT 10-U <br />Consultant Management Conflict of Interest Statement <br />EXHIBIT 10-U CONSULTANT IN MANAGEMENT SUPPORT ROLE CONFLICT OF INTEREST AND <br />1CONFIDENTIALITY STATEMENT <br />RFP/RFQ PROCUREMENT NUMBERS (if applicable): <br />PROJECT NAME (and FPN, if applicable)2: <br />APPLICABILITY: To be filled out by local agency consultants in management support role. <br />□I am an employee of a consultant under contract to the local agency that is responsible for the <br />procuring and administering of one or more consultant contracts containing either Federal or <br />State funds. <br />□I am in a management position with the local agency, my title is listed below and I have <br />attached my duty statement and scope of work. <br />□I hereby certify as follows: <br />1. I recuse myself from all potential conflicts of interest. <br />2.I will not directly or indirectly participate in, manage, or oversee any consultant <br />selection procurement process in which the consulting firm of which I am employed is <br />competing as a consultant or subconsultant. <br />3.I will not directly or indirectly influence any employee, staff member, or other <br />individual participating in any consultant selection procurement process in which the <br />consulting firm of which I am employed is as a consultant or subconsultant. <br />4.I will not directly or indirectly participate in, manage, or oversee any local agency <br />contract that is with the consulting firm of which I am employed, regardless of whether <br />the involvement of my employer in the contract is as a consultant or subconsultant. <br />Among other things, this includes my not being involved in approving changes in the <br />schedule, scope, deliverables or invoices. <br />5.I understand that if I am involved in any local agency contract that is with the consulting <br />firm of which I am employed, in violation of 1. or 2. above, that local agency contract <br />will no longer be eligible for Federal or State reimbursement because of my <br />involvement. <br />□I certify that I have read and understand my responsibilities per 23 CFR 172.7(b)(5) <br />□I fully understand that it is unlawful for a person to utilize any organization name (i.e. local <br />agency) or auxiliary organization information, which is not a matter of public record, for <br />personal gain. <br />1 Each consultant staff working in a management support role shall complete a separate form. <br />2 For on-call contracts or contracts for multiple projects, indicate accordingly. <br />Page 1 of 3 <br />January 2018 <br />Roosevelt Avenue Permanent Traffic Calming Project Engineering Design <br />ATTY/AGR.2024.181/KImley-Horn (Roosevelt Ave Permanent Traffic Calming Project De (Page 40 of 42) <br />6.B. - Page 44 of 46 <br />69