1-Conflict of Interest Statement Form.pdf

This is a Conflict of Interest Statement Form required by Florida Statute 112.313 for respondents to the Marion County debris management contract opportunity 26P-118. The form requires disclosure of any relationships between the respondent and Marion County employees, public officers, or advisory board members that could create conflicts of interest. Specifically, respondents must declare if they are county employees or officers, related to county personnel, have ownership stakes exceeding five percent in entities with county connections, employ county officials, or are former employees with less than one year of inactive service. The contract opportunity itself seeks proposals for debris monitoring and consulting services related to Phase 4 recovery operations during emergency events, with a contract term of five years plus three optional one-year renewals. Services include collection, transport, staging, reduction, processing, and disposal of debris from roadways, bike lanes, sidewalks, and rights-of-way as directed by the County.

The Conflict of Interest Statement Form requires respondents to certify their compliance status and indicate whether they will request an advisory board member waiver under Florida Statute 112.313(12). The County reserves the right to disqualify any vendor whose conflicts are not waived or determined to be exempt under the Florida Ethics Code. No specific pricing terms, set-asides, funding amounts, or other financial details are outlined in this conflict of interest disclosure form, as it serves solely as a qualification and ethics certification document required during the proposal submission process.