10-Conflict of Interest Certification.pdf
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- Solicitation number
- 25/0223
- Issued by
- Harris County, Texas
About this file
This is a Conflict of Interest Certification form issued by the Harris County Juvenile Probation Department (HCJPD) for vendors responding to a Request for Sealed Quotation (RFSQ) for Residential Services. The form requires vendors to certify that they do not have employment or business relationships with members of the Harris County Juvenile Board, Deputy Directors or similar individuals of HCJPD, or family members of these individuals that would result in taxable income exceeding $2,500 during a 12-month period. Additionally, vendors must certify that they have not provided gifts with an aggregate value exceeding $100 during a 12-month period to any of these individuals or their family members. The certification is required by Texas State Law under sections 176.003 and 176.006 of the Local Government Code. Vendors must sign and return the completed form or, if they cannot certify compliance, complete the Conflict of Interest Questionnaire instead.
The residential services contract is for the Harris County Juvenile Probation Department and is anticipated to begin approximately June 1, 2025, with an initial term of one year. The form itself contains no pricing information, set-asides, or funding details, as it serves solely as a compliance and disclosure document. Vendors must complete this certification as part of their bid or proposal submission process.
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Text version
HARRIS COUNTY JUVENILE PROBATION DEPARTMENT
CONFLICT OF INTEREST CERTIFICATION
Form updated: 06/16/2021
Instructions: State law requires vendors who are negotiating to contract or responding to a RFP or bid advertised by the local governmental entity to file a Conflict of Interest disclosure if the vendor has a business relationship with a local governmental officer or a family member of that officer. As a result, HCJPD is requiring vendors to certify the below statements, and if true, fill it out, sign and return this form. Otherwise, the vendor must complete the Conflict of
Interest Questionnaire and follow the instructions found in that form.
This form is to certify that does not have an employment or
Name of Vendor other business relationship with:
a member(s) of the Harris County Juvenile Board;
a Deputy Director(s), or similar individual of the Harris County Juvenile Probation
Department; and/or, a family member(s) of the aforementioned individual(s), that results in the aforementioned individuals receiving a taxable income in excess of $2,500 during a 12-month period. In addition, vendor has not given any Juvenile Board member(s), Deputy Director or similar individual, or family member of the aforementioned individual(s) one or more gifts with an aggregate value in excess of $100 during a 12-month period. (Please see sections 176.003 and 176.006 of the Local Government Code.)
Name of Representative Signature
Date
File details come from the government source that posted it. Updated .