2-Conflict of Interest Form- Fillable PDF.pdf
PDF 98 KB Posted
- Attached to
- RFP - Office Rooftop HVAC Replacement
- Solicitation number
- 2026-RFP-701 Rooftop HVAC-AHA-HD-010
- Issued by
- Alameda County, Anaheim City, California
About this file
This is a Conflict of Interest Certification form issued by the Housing Authority of the City of Alameda (AHA) for bidders, proposers, and vendors responding to the RFP for Office Rooftop HVAC Replacement. The form requires bidders to disclose any current or prior personal relationships, business or financial relationships, or organizational conflicts of interest with AHA officials, officers, employees, or their immediate family members and business associates. Bidders must also identify any additional projects they are currently working on in the City of Alameda. The mandatory bid walk is scheduled for Thursday, October 8, 2026, at 1:00 PM at 701 Atlantic Ave., Alameda, CA 94501. The deadline for submitting questions through the Bonfire Portal is Tuesday, October 13, 2026, at 4:00 PM, with proposal and bid submissions due Tuesday, October 27, 2026, at 4:00 PM through the same portal.
The certification requires the authorized official or representative of the bidding organization to provide their name, title, contact information, and signature, attesting under penalties of perjury that no actual or apparent conflict of interest exists regarding the award or performance of contract services. Bidders must respond to four primary certification questions regarding conflicts of interest and must provide explanations if they answer affirmatively to any question. The form does not address pricing, set-asides, or funding sources, as it functions solely as a conflict of interest disclosure and certification document required as part of the bidding process.
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Text version
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
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