2-Form 2 - Statement of Conflict of Interest.pdf
PDF 153 KB Posted
- Solicitation number
- 025-26-AIR-RFP
- Issued by
- Cameron County, Texas
About this file
This is a Statement of Conflict of Interest form issued by the Procurement Department of the City of Brownsville, Texas in October 2025 (FY26 Version 2) for the Airport Common Use Passenger Processing System (CUPPS) procurement opportunity at Brownsville South Padre Island International Airport. Respondent vendors are required to disclose any conflicts of interest related to the goods and services associated with this solicitation, including conflicts involving the service provider or key employees. Respondents must complete and submit Texas Ethics Commission Form CIQ as part of their response, or indicate "N/A" if no conflicts exist. Any identified conflicts must be accompanied by a detailed mitigation plan, which the City reserves the sole discretion to accept or reject as a basis for disqualification.
Respondents acknowledge that they have reviewed the requirements of Texas Local Government Code Chapter 176 regarding conflict of interest disclosures and understand that a completed Form CIQ must be filed with the City Secretary's Office within seven business days after becoming aware of a conflict. Respondents further acknowledge that Form CIQ is a public record available under state law and that failure to file a required form constitutes a violation of state law subject to penalties under Texas Local Government Code 176.006 and possible disqualification from award consideration. The certification section requires authorized representatives to sign and provide contact information, confirming that appropriate conflict of interest documentation has been or will be filed in accordance with state requirements.
View the file
Other files
Show all 12
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
FY26 – Version 2 Procurement Department October 2025
Form 2 - Statement Of Conflicts Of Interest (If Any)
Conflict of Interest Disclosure Instructions
The Respondent vendor must describe any conflicts of interest related to the goods and/or services associated with this solicitation.
The Respondent shall complete and submit Form CIQ (Form 2) indicating any conflicts of interest for the service provider or key employees. If no conflicts exist, the Respondent must indicate “N/A” on the form and submit it as part of their response.
A conflict of interest statement is required if any conflicts exist, along with a detailed plan for mitigating the conflict(s).
The Entity reserves the sole discretion to determine whether a conflict disqualifies a firm and/or whether a conflict mitigation plan is acceptable.
Respondent Acknowledgment
By signing below, the Respondent certifies and acknowledges the following:
1. The Respondent has reviewed the requirements of Chapter 176, Texas Local Government Code, regarding conflict of interest disclosures.
2. The Respondent understands that a completed Texas Ethics Commission Form CIQ must be filed with the City Secretary’s Office of the City of Brownsville, Texas, within seven (7) business days after the Respondent becomes aware of a conflict.
3. The Respondent acknowledges that the completed Form CIQ is a public record and will be made available by the City Secretary in accordance with state law.
4. The Respondent understands that failure to file a required Form CIQ is a violation of state law and may result in penalties under Texas Local Government Code §176.006 and possible disqualification from consideration for award.
5. The Respondent shall submit this acknowledgment form as part of its solicitation response and attach a copy of the completed TEC Form CIQ, if applicable.
City Secretary Contact Information
City of Brownsville – Office of the City Secretary 1001 East Elizabeth Street, Brownsville, Texas 78520 Email: citysecretary@brownsvilletx.gov Phone: (956) 548-6000
FY26 – Version 2 Procurement Department October 2025
Certification
By signing below, the undersigned Respondent certifies that they have read and understood the requirements of Chapter 176, Texas Local Government Code, and that the appropriate Conflict of Interest Questionnaire (Form CIQ) has been filed or will be filed as required.
Signature: ____________________________________________
Printed Name: _________________________________________
Title: _________________________________________________
Date: ______________________
Company Name: ________________________________________
Phone: ______________________
Email: _________________________________________________
| Printed Name_2: |
| Title_3: |
| Date_2: |
| Company Name_2: |
| Phone_2: |
| Email_3: |
| Signature2_es_:signer:signature: |
File details come from the government source that posted it. Updated .