23-Appendix B - Conflict of Interest Form.docx

This is a Conflict of Interest Form for a Stormwater CRRP Construction WORCS Contract issued by Hillsborough County Engineering and Operations Department in Florida. The form requires bidding firms to declare any conflicts of interest as required under 2 CFR 200.112 (Additional Applicable Federal Contract Provisions, Section 2.7.2.5). Contractors must provide their firm name, address, email, and phone number, and indicate whether they have conflicts of interest to declare concerning the solicitation. If conflicts exist, firms must provide a detailed explanation.

The contract involves as-needed culvert repair and replacement work at various locations throughout Hillsborough County, with primary work located north of I-4 and I-275, though work may be assigned throughout the county's stormwater infrastructure network. The estimated contract value is $18,258,390.04, with work to be ordered by the County on an as-needed basis. The form requires authorization by an agent and must include the agent's printed name, signature, and date of submission.