Laserfiche WebLink
Consultant Management Conflict of Interest Statement <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 />Page 1 of 3 <br />ATTY/AGR.2025.333/Kimley-Horn (Bay Road Complete Streets) (Page 48 of 50)