1-Exhibit B - Conflict of Interest Disclosure.docx

DOCX document 32 KB Posted

Attached to
City of Herriman - Solicitation for Utility Billing Software
Solicitation number
HERR03272026
Issued by
Salt Lake County, Hildale City, Utah

About this file

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This is a Conflict of Interest Disclosure Form required by the City of Herriman, Utah for vendors and contractors responding to the Request for Proposal for Utility Billing Software and professional implementation services. The form serves as a mandatory disclosure document that vendors must complete and submit with their proposals, with a submission deadline of April 30, 2026 at 5:00 PM MDT through the Utah Public Procurement Place (U3P) Bonfire system. Vendor demonstrations and interviews are scheduled for the week of June 22, 2026, preferred vendor notification is expected the week of July 13, 2026, contract negotiations commence July 20, 2026, and City Council contract award is targeted by September 9, 2026.

The disclosure form requires vendors to identify any prior work or goods and services provided to City departments within the current or last fiscal year, any grants or loans received from City departments during that period, familial relationships between the vendor's business entity or immediate family members and public officials or City employees, and the names and addresses of all paid consultants or lobbyists utilized in preparing the proposal. Vendors must also describe in detail any direct benefits to be gained by public officials or their family members as a result of the contract. All statements submitted on the form are made under oath and penalty of perjury, with omissions serving as grounds for disqualification from participation in the proposed transaction. The form does not address pricing terms, set-asides, incumbents, or funding sources, as it is solely a conflict of interest certification document required as part of the RFP submission package.

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Other files

File Type Posted
3-City of Herriman Utility Billing Software 4-3-2026 Revised.pdf PDF
2-Exhibit B - Conflict of Interest Disclosure.docx DOCX document
2-Exhibit A - Reference Form.docx DOCX document
4-Attachment C - Functional Requirements.xlsx XLSX spreadsheet
1-RFP - Utility Billing Software.pdf PDF
3-Exhibit A - Reference Form.docx DOCX document

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Attachment C – Conflict of Interest Disclosure

City of Herriman Vendor or Contractor Conflict of Interest Disclosure Form

Entity Completing Form:Click or tap here to enter text.

Address:Click or tap here to enter text.

City, State, ZIP:Click or tap here to enter text.

Phone Number:Click or tap here to enter text.

Contact Email Address:Click or tap here to enter text.

This form is provided with: Request for Proposal/Qualifications

1. Has your business entity or any of your business entities’ partners, divisions, or any related business entity previously performed work or provided goods or services to any City department within the current or last fiscal year?

Choose an item.

If yes, identify below the City department that received the goods and services, the type(s) of goods or services previously provided, and the amount received for the provision of goods or services (use additional pages if necessary)

City Department
Type of Goods/Services
Amount Received
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2. Has your business entity or any of your business entities’ partners, divisions, or any related business entity previously applied for and received any grants or loans from any City department within the current or last fiscal year?

Choose an item.

If yes, describe the type of grant or loan, the date such grant or loan was awarded, and the amount of the grant or loan.

Description of Grant or Loan
Date Grant Awarded
Amount of Grant or Loan
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3. List below the name(s) and address(es) of all public officials with whom your business entity, or members of your immediate family have a familial relationship. Identify the office the public official holds or the City department for which the public official works (attach additional sheets if necessary)

Name of Public Employee
Address
City Department
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4. List below the name(s) and addresses of all family members of public officials with whom your business entity, or members of your immediate family have a familial relationship. Identify the office the public official holds or the City department for which the public official works. Attach additional sheets if necessary).

Name of Family Member
Address
Name of Public Official/Employee Name
City Department Where Employed
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If you identified individuals in items one and/or two above, describe in detail below the direct benefit to be gained by the public officials, and/or their family members as a result of the contract, proposal, request for proposal, invitation to bid, or grant proposal. (Attach additional sheets if necessary.)

Click or tap here to enter text.

List below the name(s) and address(es) of all paid consultants and/or lobbyists utilized in preparation of this request for proposal or qualifications, invitation to bid, or grant or loan proposal:

Name of Paid Consultant/Lobbyist
Address
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By signing below, I certify under oath and penalty of perjury that all statements on or attached to this form are true and correct to the best of my knowledge. I further understand that omissions shall be cause for disqualification from participation on the proposed transaction.

Signature Date

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