1-Conflict of Interest Statement Form.pdf
PDF 1 MB Posted
- Attached to
- 26B-120 2 Cubic Yard (Cy) Stationary Garbage Compactor Units – Cram-A-Lot Model St-2hf Or Approved Alternate
- Solicitation number
- 26-120
- Issued by
- Marion County, Florida
About this file
This is a Conflict of Interest Statement Form related to Marion County Solid Waste's procurement for two cubic yard stationary garbage compactor units in Florida. The form establishes the framework for potential bidders to disclose any conflicts of interest that may exist in connection with their participation in this solicitation. The procurement seeks bids for Cram-A-Lot Model ST-2HF compactors or approved equal units, complete with remote hydraulic power units, controls, installation, startup, testing, and all required documentation. Bidders proposing alternate or "approved equal" products must submit such proposals through the Public Q & A Message section of the solicitation for County review and approval prior to the bid submission deadline.
The Conflict of Interest Statement Form serves as a compliance mechanism to ensure bidder integrity and transparency throughout the procurement process. All prospective bidders are required to complete and submit this form, disclosing any potential conflicts of interest, including financial interests, business relationships, or other circumstances that could compromise their objectivity or create improper advantages. This form is standard procurement practice and necessary to maintain the competitive fairness and validity of the bid process for the stationary garbage compactor units that must meet specified structural, hydraulic, electrical, UL, OSHA, and ANSI requirements.
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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:
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