1-Conflict of Interest Statement Form.pdf
PDF 1 MB Posted
- Attached to
- 26B-119 Solid Waste Heavy Duty Waste Containers State and local contract opportunity
- Solicitation number
- 26-119
- Issued by
- Marion County, Orlando City, Florida
About this file
This is a Conflict of Interest Statement Form required by Florida Statute 112.313 for vendors responding to Marion County's solid waste container procurement (26B-119). The form is designed to identify any conflicts of interest between respondents and Marion County employees, public officers, or advisory board members prior to contract award. Respondents must disclose whether they are county employees, relatives of county employees, have material interests in the county, employ county officials, or are former county employees with less than one year of inactive service. The form also requires respondents to indicate whether they will request an advisory board member waiver under Florida Statute 112.313(12).
The County reserves the right to review any relationships that may be prohibited under the Florida Ethics Code and will disqualify any vendor whose conflicts are not waived or exempt from the conflict of interest restrictions. Completion of this form is mandatory for all bidders submitting proposals for the heavy-duty waste containers project, which involves the manufacture and delivery of compactor receiver containers and various roll-off containers to Marion County Solid Waste in Ocala, Florida.
View the file
Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 4-Vendor Information Form.pdf | ||
| 3-Similar Work Detail Form.pdf | ||
| 6-ITB - General Terms and Conditions.pdf | ||
| 2-Disclosure of Subcontractors and Suppliers.pdf | ||
| 7-Scope of Work.pdf | ||
| 5-PaymentWorks Onboarding Letter.pdf |
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
CONFLICT OF INTEREST STATEMENT
Florida Statute §112.313 places limitations on public officers (including advisory board members) and employees' ability to contract with the County either directly or indirectly. Therefore, please indicate if the following applies:
PART 1.
I am an employee, public officer, or an advisory board member of the County (LIST).
NAME:
I am the spouse or child of an employee, public officer or advisory board member of the County.
NAME:
An employee, public officer, or advisory board member of the County, or their spouse or child, is an officer, partner, director, or proprietor of Respondent or has a material interest in Respondent. "Material interest" means direct or indirect ownership of more than five percent (5%) of the total assets or capital stock of any business entity. For the purposes of FS §112.313, indirect ownership does not include ownership by a spouse or minor child.
NAME:
Respondent employs or contracts with an employee, public officer, or advisory board member of the County.
NAME:
Principal or Agent is former employee of MCBCC with less than one (1) year of inactive service.
NAME:
NONE OF THE ABOVE
PART 2.
Are you going to request an advisory board member waiver?
I will request an advisory board member waiver under FS §112.313(12)
I will NOT request an advisory board member waiver under FS §112.313(12)
N/A
The County shall review any relationship which may be prohibited under the Florida Ethics Code and will disqualify any vendor whose conflicts are not waived or exempt.
COMPANY:
PRINTED NAME:
SIGNATURE:
| NAME: |
| NAME_2: |
| NAME_3: |
| NAME_4: |
| NAME_5: |
| Check Box: Off |
| Check Box3: Off |
| Check Box5: Off |
| Check Box6: Off |
| Check Box7: Off |
| Check Box8: Off |
| Check Box9: Off |
| PRINTED NAME: |
| COMPANY: |
| Check Box1: Off |
| Check Box4: Off |
| Signature_es_:signature: |
File details come from the government source that posted it. Updated .