14-Conflict of Interest Form- Fillable PDF.pdf

98 KB Posted

Attached to
Document Digitation Services
Solicitation number
RFP-RFP 26-2971-DP-0-2027/DP
Issued by
San Diego County, California

About this file

Written by GovTribe AI ·

This is a Conflict of Interest Certification form required by the Housing Authority of the City of Alameda (AHA) for bidders, proposers, and vendors submitting proposals for the Document Digitization Services contract in California. The form serves as a standardized disclosure document to identify potential conflicts of interest before contract award. Bidders must certify whether they have any current or prior personal relationships with AHA officials, officers, employees, or their immediate family members; any business or financial relationships with AHA personnel or associates; any other relationships requiring disclosure; or any actual or apparent organizational conflicts of interest. Additionally, bidders must disclose any other projects they are currently working on within the City of Alameda. The form requires the authorized official or representative of the bidding firm to provide their name, title, signature, and date, affirming under penalties of perjury that no conflicts of interest exist.

The certification form includes checkboxes for yes/no responses to each conflict of interest question, with space provided for explanations if affirmative responses are selected. Bidders must provide their business name, address, and primary contact information at AHA or project name. The form is designed to ensure transparency and maintain the integrity of the procurement process by requiring disclosure of any relationships or interests that could compromise impartial contract performance or create unfair competitive advantages.

View the file

Other files

File Type Posted
12-07-Bid Package- Project Manual IP WATER DAMAGE.pdf PDF
11-04-Bid Package - Sample AHA Contruction Services Agreement IP WATER DAMAGE.pdf PDF
13-2026 ITB WATER DAMAGE IP-AHA-HD-009 FINAL.pdf PDF
8-12-Bid Package- Licensed Subcontractors List IP WATER DAMAGE.pdf PDF
9-05-Bid Package - Bid Form Independence Plaza Water Damage Repairs at 703 and 711 Atlantic Ave Fillable.xlsx XLSX spreadsheet
3-06-Bid Package - Bid Form IP WATER DAMAGE XX.pdf PDF
5-09-Bid Package- References IP WATER DAMAGE XX.pdf PDF
6-10-Bid Package- Insurance IP WATER DAMAGE.pdf PDF
1-EXHIBIT C- INSURANCE REQUIREMENTS 2025.pdf PDF
2-05-Bid Package - Bid Form Independence Plaza Water Damage Repairs at 703 and 711 Atlantic Ave.pdf PDF
7-11-Bid Package- Safety Experience IP WATER DAMAGE XX.pdf PDF
15-711 Atlantic Ave Floorplans.pdf PDF
10-03-Bid Package - Scope of Work IP WATER DAMAGE.pdf PDF
4-08-Bid Package- Profile of Proposer IP Water Damage.pdf PDF
Show all 14

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

HOUSING AUTHORITY OF THE CITY OF ALAMEDA CONFLICT OF

INTEREST CERTIFICATION

(a) Does the Bidder/Proposer/Vendor have any current or prior personal relationships with AHA current or former official, officer or employee or their immediate family member or business associate to disclose?*

(b) Does the Bidder/Proposer/Vendor have any current or prior business or financial relationships with AHA current or former official, officer or employee or their immediate family member or business associate to disclose?*

(c) Does Bidder/Propose/Vendor have any current or prior relationship with AHA current or former official, officer or employee or their immediate family member or business associate to disclose?*

(d) Is there an organizational conflict of interest, whether actual or apparent that the Bidder/Proposer/Vendor is aware of, or there is reason to be aware of, at the time of this submittal concerning any past, present, or currently planned interest, financial, contractual, organizational, or otherwise, relating to the work to be performed hereunder?*

Additional projects in the City of Alameda*

Name of Bidder/Proposer/Vendor*

Yes No

Yes No

Yes No

Yes No

Please list any other projects you are currently working on in the City of Alameda.

7/10/26, 4:03 PM New Submission https://form.alamedahsg.org/Forms/A4Gpo 1/2

Address of Bidder/Proposer/Vendor*

Name of Authorized Official or Representative of Bidder/Proposer/Vendor*

Title of Authorized Official or Representative of Bidder/Proposer/Vendor*

Name of primary contact at AHA and/or project name*

Signature*

City State / Province / Region

Postal / Zip Code Country

Street Address

Address Line 2

The undersigned Bidder/Proposer/Vendor hereby certifies and affirms under penalties of perjury, that to the best of this Bidder/Proposer/Vendor’s knowledge and belief, no actual or apparent conflict of interest exists as to the award of the contract to Bidder/Proposer/Vendor and to the performance of contract services by Bidder/Proposer/Vendor as described in Parts I, II, and III of Part A of the certification. The undersigned official certifies that he/she is authorized to sign this bids/proposals form for the firm.

7/10/26, 4:03 PM New Submission https://form.alamedahsg.org/Forms/A4Gpo 2/2

Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off
Check Box7: Off
Check Box8: Off
If yes, please explain:
Text13:
Text14:
Text15:
Text16:
Text17:
Text18:
Text19:
Text20:
Text21:
Text22:
Text23:
Date25_af_date:

File details come from the government source that posted it. Updated .