2-Public Disclosure Form 2-17-26.pdf
PDF 114 KB Posted
- Attached to
- Computers and Accessories
- Solicitation number
- Bid 27008HCF
- Issued by
- Clark County, Fish Springs CDP, Nevada
About this file
This is a Public Disclosure Form required by the Clark County School District in Las Vegas, Nevada for vendors and contractors seeking to do business with the district. The form requires comprehensive disclosure of any potential conflicts of interest, including current or former employment relationships with the district, ownership stakes in contracting companies, and personal or financial relationships between company representatives and district board members or authorizing officials. Specifically, respondents must certify their employment status relative to the district, identify all company officers and key employees with their current employment status at the district, and disclose any relationships or financial interests between company personnel and district trustees or officials. The form applies to this contract opportunity for computers and accessories purchases by the district.
The form serves as a compliance mechanism to ensure transparency and prevent conflicts of interest in the procurement process. Failure to disclose all relevant facts regarding potential conflicts may result in termination of the contract or agreement. The district references applicable regulations including District Policy 4270 (Conflict of Interest: All Employees), District Regulation 4371 (Employees "Cooling Off" Period), and District Regulation 3312 (Purchasing Authorization and Nepotism). The form requires signature by an authorized company representative and submission to the appropriate district entity for either approval or notation that approval is not required. The document was updated as of February 17, 2026, and is referenced as form PUR-F0003, Revision B, with additional information available on the district website at www.ccsd.net.
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Text version
Public Disclosure Form
Clark County School District Las Vegas, NV
Company/Individual’s Name:
Federal Tax ID # (EIN or SSN):
1. Unless otherwise indicated, I certify that I am not currently an employee of the Clark County School District (the “District”) nor have I been an employee of the District within the past year.
2. If the person performing the work was a previous District employee and is self-employed or is an owner or part owner in the company they work for, information must be provided, as follows:
Dates employed with the District: _____________________ Position held _____________________________________
Employment terminated on: ____________________ Last Paycheck date: ____________________________________
3. Unless otherwise indicated, I certify that the officers of this company are not currently employees of the District nor have they been employees of the District within the past year.
Please complete the following. Additional sheets may be attached if necessary. Write “none” if applicable.
Company Employee Name/Individual’s Name
Position within Company
Are they Currently a District Employee? Separation Date if a Former District Employee
4. I certify that I have listed all personal relationships and financial interests between the company, company officers, and key employees with current and former District Board of School Trustees, and current and former District authorizing officials.
Please complete the following. Additional sheets may be attached if necessary. Write “none” if applicable.
Company Employee Name/Individual’s Name
Position within Company
Are they Currently a District Official/Trustee? Relationship to/Interest with District
Official/Trustee
5. I hereby acknowledge that failure to disclose all facts relative to a conflict or potential conflict of interest with regard to my contract/agreement with the District may result in termination of said contract/agreement.
(Applicable District Regulations can be accessed on the District website www.ccsd.net . These include District Policy 4270, Conflict of Interest: All Employees; District Regulation 4371, Employees “Cooling Off” Period; and District Regulation 3312, Purchasing Authorization and Nepotism – All Funds.)
Individual or Authorized Company Representative
Signature:
Title: Date:
Email address: Phone Number
For Internal Use
Approval Required District Entity Signature/Reference Date
Board of School Trustees
Deputy Superintendent/Operations
Approval Not Required
Updated 2-17-2026 PUR-F0003, Rev. B http://www.ccsd.net/
File details come from the government source that posted it. Updated .