3-DISCLOSURE STATEMENT.pdf
PDF 20 KB Posted
- Solicitation number
- BC-RFQ-25-008.2
- Issued by
- Bergen County, New Jersey
About this file
This document is a Disclosure Statement form for Bergen County, New Jersey, specifically addressing potential conflicts of interest under the Local Government Ethics Law (N.J.S.A. 40A:9-22-1). The form requires bidders to disclose whether they, or any members of their immediate family or business organization, are currently Bergen County officers or employees. Bidders must transparently indicate their status by checking either "YES" or "NO" and providing a signature from an authorized company representative.
The form emphasizes ethical compliance by prohibiting County officers or employees from having business interests that substantially conflict with their public duties. If a bidder answers "YES" to having a County connection, they must provide the individual's name and position, and notify the Office of County Counsel in writing. The document warns that failure to sign the affidavit by a duly authorized company official may result in proposal rejection, underscoring the critical nature of this disclosure requirement for potential contractors and vendors seeking to do business with Bergen County.
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Text version
DISCLOSURE STATEMENT
The attention of prospective bidders is drawn to the provisions of the Local Government Ethics Law (N.J.S.A. 40A:9-22-1, et seq.) which prohibits a County Officer or employee or member of his/her immediate family from having an interest in a business organization or engaging in any business transaction, or professional activity which is in substantial conflict with the proper discharge of his duties in the public interest.
In furtherance thereof, every bidder must disclose below, being a Bergen County officer or employee or whether an immediate family member is a Bergen County officer or employee. If the bidder is a business organization, then disclosure shall be made with respect to anyone having an interest in the business and their immediate family members.
Please answer the following:
Is the bidder, or a member of the bidder’s immediate family, or anyone having an interest in the bidder’s business organization including their immediate family members, an officer or employee of Bergen County?
NO ____________________ YES ____________________
S\_________________________________________
* President, Vice President or Signature of
Authorized Representative
Print Name
Title
If yes, provide the name of the individual and identify the position held, below, and notify in writing the Office of County Counsel, One Bergen County Plaza, Hackensack, New Jersey 07601. (Attach a copy of the correspondence to this form).
NOTE: All terms used herein are to be construed in accordance with their meaning under the Local Government Ethics Law, cited above.
* FAILURE TO SIGN THIS AFFIDAVIT BY A DULY AUTHORIZED COMPANY OFFICIAL
MAY RESULT IN REJECTION OF THIS PROPOSAL.
File details come from the government source that posted it. Updated .