1-Conflict of Interest Statement Form.pdf

This is a Conflict of Interest Statement Form required by Florida Statute 112.313 for use in Marion County contract procurements. The form is designed to identify potential conflicts of interest involving County employees, public officers, advisory board members, and their immediate family members in relation to vendor respondents. The form requires disclosure if the respondent or any principal or agent has direct employment relationships, material financial interests exceeding five percent ownership, family relationships, or prior employment with the County within one year of inactive service. Respondents must also indicate whether they will request an advisory board member waiver under Florida Statute 112.313(12). The form includes signature lines for company representatives and printed names for all relevant parties involved in the proposal submission.

The document serves as a compliance mechanism to ensure adherence to Florida's Ethics Code and prevent prohibited vendor relationships as defined under state law. Completion and submission of this form is mandatory for all respondents to state and local contract opportunities issued by Marion County, with the County retaining the authority to review disclosed relationships and disqualify vendors whose conflicts cannot be waived or are not exempt under applicable ethics regulations. The form does not address pricing, contract terms, or specific procurement details but rather functions as a prerequisite eligibility document for vendor participation in the solicitation process.