14-TOPB Conflict of Interest Form General.pdf

This is a Conflict of Interest Form issued by the Town of Palm Beach, Florida, for use by entities seeking to do business with the Town under sealed competitive proposals. The form requires bidders to certify compliance with Florida Statutes Section 112.313(3) and (7), which address conflicts of interest in public procurement. Bidders must declare whether their business impacts any public officer or employee of the Town of Palm Beach or Palm Beach County. If an impact exists, the affected public officer or employee must have filed a disclosure statement with the Town prior to proposal submission using Florida Commission on Ethics Form 3A, detailing the nature of the intended business and the interest of the officer, employee, or their spouse or child. The authorized agent of the firm must sign and date the form, providing company name, contact information, and phone number to complete the certification.

The form establishes a mandatory compliance requirement for all entities bidding on Town of Palm Beach contracts awarded through competitive sealed proposal systems. Failure to properly disclose conflicts of interest or to obtain required ethics filings from impacted public officials or employees may result in proposal rejection or contract disqualification. The form serves as a standard requirement applicable across all Town procurement activities, including the Emergency Food Services contract (RFP 2026-014) for catering services to provide meals for approximately 250 employees per day following disasters or at social events.