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<br />City of Everett REQUEST FOR QUALIFICATIONS <br />RFQ No. 2023-164 <br />Walter E. Hall Park Community Connections Path <br /> <br />CERTIFICATION REGARDING CONFLICT OF INTEREST <br /> <br />The Vendor is required to certify that performance of the work will not create any conflicts of <br />interest or disclose any actual or potential conflicts of interest by completing and signing one of <br />the following statements: <br /> <br />The Vendor hereby certifies under penalty of perjury under the laws of the State of Washington that to the best of its <br />knowledge and belief, performance of the services described in the Scope of Work will not create any conflicts of interest <br />for the Vendor, any affiliates, any proposed subconsultants or key personnel of any of these organizations. <br />Vendor/Company Name: <br />Authorizing Official Name: Authorizing Official Title: <br />Authorizing Official Signature: Date: <br />OR <br />Name of Individual/Company to which potential conflict of interest might apply: <br />Nature of potential conflict of interest: <br />Proposed Remedy: <br />Vendor/Company Name: <br />Authorizing Official Name: Authorizing Official Title: <br />Authorizing Official Signature: Date: <br /> <br />Board & Vellum <br />Zack Thomas Principal <br />February 14, 2024