Bryan McKinney - Conflict of Interest Statementta Qa;Kr(V
— GEM ofthe DESERT —
PANEL MEMBER CONFLICT OF INTEREST AND CONFIDENTIALITY STATEMENT
RFP/RFQ PROCUREMENT NUMBERS:
PROJECT NAME:
On -Call Building Plan Review and Inspection Services
APPLICABILITY:
,I 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.
11, certify that I have no current contractual relationship with any of the firms (including
subconsultants) that are the subject of this evaluation.
IKI 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.
certify that I have read 49 CFR 18.36(b)(3) below and I agree not to participate in selection,
or in the award or administration of a contract supported by Federal funds if a coliflict of
interest, real or apparent, would be involved. Note: Caltrans is the Grantee and the local agency
is the sub -grantee.
49CFR 18.36(b)(3)
(3) Grantees and subgrantees will maintain a written code of standards of conduct
governing the performance of their employees engaged in the award and administration of
contracts. No employee, officer, or agent of the grantee or subgrantee shall participate in
selection, or in the award or administration of a contract supported by Federal funds if a
conflict of interest, real or apparent, would be involved. Such a conflict would arise when:
(i) The employee, officer, or agent,
(ii) Any member of his immediate family,
(iii) His or her partner, or
(iv) An organization which employs, or is about to employ, any of the above, has a
financial or other interest in the firm selected for award. The grantee's or subgrantee's
officers, employees or agents will neither solicit nor accept gratuities, favors or anything
of monetary value from contractors, potential contractors, or parties to subagreements.
Grantee and subgrantees may set minimum rules where the financial interest is not
substantial or the gift is an unsolicited item of nominal intrinsic value. To the extent
permitted by State or local law or regulations, such standards or conduct will provide for
penalties, sanctions, or other disciplinary actions for violations of such standards by the
grantee's and subgrantee's officers, employees, or agents, or by contractors or their agents.
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GEM of the DESERT — —
,%,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.
AI 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.
I am aware that the following firms and subconsultants/subcontractors have submitted
proposals in response to the above referenced solicitation:
List firms including subconsultants/subcontractors:
1. Prime: HR Green
Subs: LandMark Consultant, Inc.
2. Prime: CSG Consultants
3. Prime: Transtech Engineers, Inc.
4. Prime: JAS Pacific
5. Prime: Wilidan Fn ig neering
6. Prime: Interwest Consulting Group
7. Prime: West Coast Code Consultants, Inc.
8. Prime: EsGil LLC
9. Prime: Bureau Veritas North America, Inc.
Date: Z `-311S Signed:
Name:.(��
Title: [ ! 14,l2Gj/C�Pr
Dept./Local Agency:
Employer: C4 a ' X 001444