25-8426_Form_1_Vendor_Declaration_Statement.pdf
PDF 161 KB Posted
- Attached to
- Collection Agency Services
- Solicitation number
- 25-8426
- Issued by
- Collier County, Florida
About this file
This is a Vendor Declaration Statement form issued by the Collier County Board of County Commissioners for a Collection Agency Services Request for Proposals managed by the Emergency Medical Services Division. The form requires vendors submitting proposals to certify that their response is made without collusion or fraud and in compliance with the County's Procurement Ordinance and Ethical Standards. Vendors must declare that no elected or appointed county officials, their spouses, or household members have a financial interest exceeding one percent (1%) of total assets or capital stock in the vendor's company or any related subcontractors or suppliers. Additionally, vendors must disclose any relatives of county officials or employees with financial interests in the proposed goods or services. The declaration requires vendors to confirm they have fully examined and accepted all instructions, purchase order terms, conditions, requirements, and specifications outlined in the solicitation and agree to comply with all stated terms and pricing.
The vendor declaration must be signed by a duly authorized corporate representative with signature authority and submitted under penalties of perjury. If awarded, the vendor agrees to execute either a Purchase Order or formal Collier County contract to establish the contractual relationship. A critical provision prohibits vendors from marking up fees for related entity subcontractors, with related entities defined as parent or subsidiary companies or any business in which the vendor holds direct or indirect ownership interest. The County has historically spent approximately $940,000 on collection agency services, though this may not reflect future purchasing patterns. This declaration form serves as a prerequisite to bid submittal and ensures compliance with County procurement standards and conflict-of-interest regulations.
View the file
Other files
Show all 25
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
Version 2 9.2.25
Form 1: Vendor Declaration Statement
BOARD OF COUNTY COMMISSIONERS
Collier County Government Complex Naples, Florida 34112
Dear Commissioners:
The undersigned, as Vendor declares that this response is made without connection or arrangement with any other person and the bid/proposal submittal is in every respect fair and made in good faith, without collusion or fraud and in compliance with the Procurement Ordinance, Section Seven, Ethical Standards.
The vendor certifies to the best of their knowledge or belief, no elected/appointed official or employee of Collier County, a spouse thereof or other person residing in the same household, is financially interested, directly or indirectly, in providing the goods or services specified in any submitted bid or proposal. A financial interest is defined as ownership of more than one percent (1%) of the total assets or capital stock or being an officer, director, manager, partner, proprietor, or agent of the business submitting the bid or proposal or of any subcontractor or supplier thereof providing goods or services in excess of one percent (1%) of the total bid or proposal amount. Additionally, the vendor, on company letterhead, must divulge at the time of the submittal of a bid or proposal, any relative, other than those already specified, of an elected or appointed official or employee of the County who has a financial interest, in providing the goods or services specified in the bid or proposal. The County, at its sole discretion, will determine whether a conflict exists and whether to accept or reject the bid or proposal.
The Vendor hereby declares the instructions, purchase order terms and conditions, requirements, and specifications/scope of work of this solicitation have been fully examined and accepted.
The Vendor agrees, if this solicitation submittal is accepted by Collier County, to accept a Purchase Order as a form of a formal contract or to execute a Collier County formal contract for purposes of establishing a contractual relationship between the Vendor and Collier County, for the performance of all requirements to which this solicitation pertains. The Vendor states that the submitted is based upon the documents listed in this solicitation. The Vendor agrees to comply with the requirements in accordance with the terms, conditions and specifications denoted herein and according to the pricing submitted as a part of the Vendor’s bids.
Further, the Vendor agrees that if awarded a contract for these goods and/or services and a subcontractor is a related entity to the Vendor, then the Vendor shall not mark-up the subcontractor’s fees. A related entity shall be defined as any parent or subsidiary of the company and any business, corporation, partnership, limited liability company or other entity in which the company or a parent or a subsidiary of the company holds any ownership interest, directly or indirectly.
Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge and a duly corporate authorized representative with signature authority.
Company Name: _________________________________________
Date: _____________________________
Signature: ____________________________________________ Title: _____________________________
| Company Name: |
| Date19_af_date: |
| Title: |
File details come from the government source that posted it. Updated .