2-Disclosure FY26 Update.pdf
PDF 128 KB Posted
- Attached to
- Utilities Technology Master Plan (UTMP) and Customer Information System (CIS) Consulting Services
- Solicitation number
- 2026003
- Issued by
- Indian River County, Florida
About this file
This document is a Disclosure of Relationships form from Indian River County, Florida, designed to ensure transparency and compliance with local government conflict of interest regulations. The form requires businesses or individuals submitting documents to the county to disclose any familial or professional relationships with county commissioners or employees. The disclosure covers a wide range of relationships, including immediate and extended family members, as well as officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an entity.
The form mandates that if any such relationships exist, they must be explicitly detailed in section 5b of the document. Respondents are required to swear under penalty of perjury that the information provided is true and commit to notifying the county's purchasing department (purchasing@indianriver.gov) if any new affiliate relationships are identified after the form's submission. The purpose of this document is to maintain ethical standards and prevent potential conflicts of interest in county business transactions by ensuring full transparency about personal and professional connections between private entities and county government personnel.
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Other files
| File | Type | Posted |
|---|---|---|
| 7-NDA for RFP 2026003.pdf | ||
| 1-Anti-Human Traffic.pdf | ||
| 3-Scrutinized.pdf | ||
| 4-RFP-RFQ Compliance Form.pdf | ||
| 5-Foreign Entity Ownership.pdf | ||
| 8-RFP 2026003 for UTMP CIS Consulting Services.pdf | ||
| 6-Firm Information Form.pdf | ||
| 9-Sample Agreement.docx | DOCX document |
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Text version
Disclosure of Relationships -1
DISCLOSURE OF RELATIONSHIPS
1. This sworn statement is submitted by (firm name):
whose business address is: .
2. My name is and my relationship to the entity named above is .
3. I understand that as defined in Section 105.06, Indian River County Code, the term
“affiliate” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of the entity.
4. I understand that the relationship with a County Commissioner or County employee that must be disclosed as follows:
Self (current county employee or commissioner), father, mother, son, daughter, brother, sister, uncle, aunt, first cousin, nephew, niece, husband, wife, father-in-law, mother-in-law, daughter-in-law, son-in-law, brother-in-law, sister-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half brother, half sister, grandparent, or grandchild.
5. Based on information and belief, the statement, which I have marked below, is true in relation to the entity submitting this sworn statement. [Please select either a. or b.]
a. Neither the entity submitting this sworn statement, nor any officers, directors, executives, partners, shareholders, employees, members, or agents who are active in management of the entity, have any relationships as defined in section 105.06, Indian River County Code, with any County Commissioner or County employee; or,
b. The entity submitting this sworn statement, or one or more of the officers, directors, executives, partners, shareholders, employees, members, or agents, who are active in management of the entity have the following relationships with a County Commissioner or County employee:
Name of Affiliate of entity Name of County Commissioner or employee Relationship
6. Should a new affiliate relationship be identified after the submittal of this form, I will notify purchasing@indianriver.gov.
7. I hereby swear, under penalty of perjury, the information provided on this form is true.
(Signature)
(Date) mailto:purchasing@indianriver.gov
| 1 This sworn statement is submitted by firm name: |
| whose business address is: |
| 2 My name is: |
| my relationship to the entity named above is: |
| a: |
| b: |
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