25-8426_Form_1_Vendor_Declaration_Statement.pdf
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- 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 in Naples, Florida, in connection with Request for Proposals (RFP 25-8426) for Collection Agency Services. The County seeks a qualified collection agency to manage delinquent and non-deliverable accounts receivable from the Emergency Medical Services Division, with an estimated annual volume of approximately 10,500 accounts totaling approximately $8.8 million in receivables, with monthly placements averaging $550,000 to $1,418,000. Most accounts will be assigned when they reach 120 days past due. Proposals must be submitted electronically by March 12, 2026, at 3:00 PM EST and remain valid for 180 days. The County intends to award a single contract for an initial three-year term with two optional one-year renewal periods.
The vendor must certify that the proposal is submitted in good faith without collusion or fraud, that no elected or appointed officials or their household members have financial interests in the vendor's business, and that all instructions, terms, conditions, requirements, and specifications have been fully examined and accepted. Vendors must disclose any relatives of county officials with financial interests in the proposed services, and the County reserves the right to determine conflicts and accept or reject bids accordingly. The vendor agrees to comply with all contract requirements, terms, conditions, and specifications, and if awarded and utilizing a related entity subcontractor, the vendor shall not mark up the subcontractor's fees. The form requires signature by a duly authorized corporate representative under penalties of perjury, certifying the accuracy of the information provided.
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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: _____________________________
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