Conflict of Interestta
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GEM of the DESERT — -
PANEL MEMBER CONFLICT OF INTEREST AND CONFIDENTIALITY STATEMENT
PROJECT NAME:
Hiahwav I I I Corridor Area Plan
APPLICABILITY:
it/, 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.
2I 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.
h/I certify that I have no current contractual relationship with any of the firms (including
subconsultants) that are the subject of this evaluation.
S�'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.
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/RFQabove. 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.
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ta 0aiArcu
GEM of the DESERT — —
M 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.
I am aware that the following firms and subconsultants/subcontractors have submitted
proposals in response to the above referenced solicitation:
List firms:
Kimley Hom (Riverside, CA)
Torti Gallas and Partners Los An eles CA
De Novo Planning Group (Tustin, CA)
MIG (San Diego, CA)
Rangwalla Associates Team (.Los Angeles, CA)
Design Workshop (Los Angeles, CA}
KTGY Architecture and Plannin Firm irm (Irvine, CA)
Dudek (La Quinta, CA)
Terra Nova Planning and Research (Palm Desert, CA)
Placeworks (Santa Ana, CA)
FORMA Design Inc (Costa Mesa, CAS
MSA Consulting (Rancho Mirage, CA}
The .Altura Group (Palm Desert, CA)
MW Steele Group Inc. (San Diego. CA)
Michael Baker International (Santa Ana, CAS
Date: 11 2�0
Signed: 0&�
Name: lam' l 6_n
Title: &,10 1-0 r
mof
�I o r'e S
�la-n ►per
ept. Local Agency: ? SIB V evNeA -":::"
Employer:
taQuu��
GEM of the DESERT —
PANEL MEMBER CONFLICT OF INTEREST AND CONFIDENTIALITY STATEMENT
PROJECT NAME:
Highway 111 Corridor Area Plan
APPLICABILITY:
;k� 1 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.
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.
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
proposalsibids.
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/RFQabove. 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.
GEM of the DESERT — —
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.
Yr-1' I am aware that the following firms and subconsultants/subcontractors have submitted
proposals in response to the above referenced solicitation:
List firms:
1. Kimley Horn (Riverside, CA)
2. Torti Gallas and Partners [Los Angeles, CAS
3. De Novo Planning Group (Tustin. CA)
4. MIG (San Diego, CA)
5. Ranawalla Associates Team (Los Angeles, CAi
6. Design Workshop (Los Angeles, CA)
7. KTGY Architecture and Planning Firm (Irvine, CA)
8. Dudek (La Quinta, CA)
9. Terra Nova Planning and Research (Palm Desert, CA)
10. Placeworks (Santa Ana. CA)
11. FORMA Design Inc (Costa Mesa, CA)
12. MSA Consulting (Rancho Mirage, CA)
13. The Altum Group (Palm Desert, CA)
14. MW Steele Group Inc. (San Diego, CA)
15. Michael Baker International (Santa Ana, CA)
Date: �� �� �'/ J� l� Signed:
Name:
Title: [_ 7�•,1�����'�,�'
Dept./Local Agency: e bevc r&/I
Employer: