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GEM oftbe DESERT —
PANEL MEMBER CONFLICT OF INTEREST AND CONFIDENTIALITY STATEMENT
PROJECT NAME:
On -Call Architectural Design Services
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26 am an employee of the local agency that is responsible for this procurement.
❑ I am an employee of a consultant under contract to the local agency that is responsible for this
procurement but I am not in a management position with the local agency.
❑ I have a personal, financial, or business interest in past employment activity or a personal
relationship regarding the firms (including subconsultants) that are the subject of this
evaluation. A brief description is provided on the back of this form.
❑ I certify that I have no current contractual relationship with any of the firms (including
subconsultants) that are the subject of this evaluation.
❑ I certify that I have no personal or financial interest and no present or past employment activity
or personal relationship or prior contractual relationship which would be incompatible with my
participation in this solicitation process and I am fully able to give full, fair and impartial
consideration to all proposals/bids as an appointee to the related evaluation.
0"'I fully understand and agree to immediately disqualify myself as soon as I am aware of a
conflict of interest that may compromise my fair and impartial consideration of the
proposals/bids.
�I certify that I will hold in the strictest confidence all bids, proposals, correspondence,
memoranda, working papers, or any other media which has any bearing on, or disclose any
aspect of, any respondent or potential respondent to the RFP/RFQ above. I will not discuss the
evaluation process with anyone not involved in the evaluation process until its completion.
I fully understand that it is unlawful for a person to utilize any organization name or auxiliary
organization information, which is not a matter of public record, for personal gain.
Wr'*'I fully understand that any violation of the above is a basis for disciplinary action, up to and
including termination or referral to the appropriate authorities for further investigation.
Lill am aware that the following firms and subconsultants/subcontractors have submitted
proposals in response to the above referenced solicitation:
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GEM of the DESERT — —
List firms including subconsultants/subcontractors:
I . BMLA Landscape Architecture
2, Community Works Design Group
3. David Evans and Associates
4. David Volz Design
5. Hermann Design Group
Date: -!Of- /9 /.�' Signed:z,e6'
Name: "r [(�a�✓�!/
Title: 9C�Ves'Wevfl-
Dept./Local Agency:.�/,s
Employer:i��,,,;aQa