2-06-Vendor Integrity and Financial Interest Disclosure.docx
DOCX document 21 KB Posted
- Solicitation number
- US.260927
- Issued by
- Bucks County, Pennsylvania
About this file
This is a Vendor Integrity and Financial Interest Disclosure Form for the County of Bucks, Pennsylvania, related to an RFQ for Purchase, Delivery and Installation of AV Upgrades for the Bucks County Public Safety Training Center (RFQ Number: PUR00226). The form requires vendors to provide representations and warranties regarding their integrity and any potential conflicts of interest before submitting a bid.
The form contains two primary sections. Part I requires vendors and vendor-related parties to certify that, within the past five years, they have not been indicted or convicted of crimes involving moral turpitude or business honesty; suspended, debarred, or disqualified by any governmental agency; had any business or professional license suspended or revoked; been subject to sanctions or findings of fraud, bribery, bid-rigging, or embezzlement; or been subject to criminal or civil antitrust investigations. Vendors must either confirm compliance with all representations or provide a written explanation if unable to certify. Part II requires disclosure of any financial interests exceeding 5% ownership or management positions in other subgrantees, contractors, subcontractors, or suppliers providing services or materials under the agreement. The authorized representative must sign and certify the accuracy of the information provided and their authority to bind the vendor to these provisions.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 6-General Information.docx | DOCX document | |
| 3-04-Nondsicrimination Sexual Harassment Certificate.docx | DOCX document | |
| 1-01-RFQ Instructions.docx | DOCX document | |
| 5-03-Terms and Conditions.docx | DOCX document | |
| 7-Specification.docx | DOCX document | |
| 4-07-Worker Protection and Investment Certification.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
05 – Vendor Integrity and Financial Interest Disclosure Vendor Integrity & Financial Interest Disclosure Form
| Project Name: | Purchase, Delivery and Installation of AV Upgrades for the Bucks County Public Safey Training Center |
| RFQ Number: | PUR00226 |
| Vendor Name: | ________________________________________________________ |
Part I: Integrity Representations & Warranties By signing this form, the undersigned authorized representative of the Vendor represents and warrants that, except as explained in an attached written statement, neither the Vendor nor any "Vendor Related Parties" (as defined in the RFQ’s Terms and Conditions) have, within the last five (5) years:
1. Been indicted or convicted of a crime involving moral turpitude or business honesty.
2. Been suspended, debarred, or disqualified by any governmental agency.
3. Had any business or professional license suspended or revoked.
4. Been subject to sanctions or findings of fact regarding fraud, bribery, bid-rigging, or embezzlement.
5. Been the subject of a criminal or civil anti-trust investigation.
Check one:
☐ I certify that the Vendor meets all representations above.
☐ I cannot certify the above and have attached a written explanation.
Part II: Disclosure of Financial Interest In accordance with the Contractor Integrity Provisions, the Vendor must disclose if it has a Financial Interest (ownership of >5% or a management/officer position) in any other subgrantee, contractor, subcontractor, or supplier providing services or materials under this agreement.
Check one:
☐ NO FINANCIAL INTEREST. The Vendor and its Related Parties do not have a financial interest in any other entity providing services, labor, or material under this agreement.
☐ FINANCIAL INTEREST DISCLOSED. The Vendor has a financial interest in the following entities involved in this project:
| Name of Entity |
| Nature of Financial Interest |
(e.g. % ownership, officer title, etc.)
(Attach additional pages if necessary)
Signature I hereby certify that the information provided above is true and correct to the best of my knowledge and that I am authorized to bind the Vendor to these provisions.
Authorized Signature: __________________________________________ Printed Name: _________________________________________________ Title: ____________________________________ Date: _______________
Section 06 – Vendor Integrity and Financial Interest Disclosure AV Upgrades for the Bucks County Public Safey Training Center
File details come from the government source that posted it. Updated .