3-DISCLOSURE STATEMENT.pdf
PDF 20 KB Posted
- Solicitation number
- BC-RFQ-26-006
- Issued by
- Bergen County, New Jersey
About this file
This is a Disclosure Statement form required by Bergen County, New Jersey for the Licensed Site Remediation Professional Request for Qualifications (BC-RFQ-26-006). The disclosure statement is mandated under the Local Government Ethics Law (N.J.S.A. 40A:9-22-1, et seq.) and applies to all prospective bidders responding to Bergen County solicitations. The form requires bidders to disclose whether they, any immediate family members, or anyone with an interest in their business organization are officers or employees of Bergen County. The contract opportunity seeks qualification statements from respondents with expertise in providing licensed site remediation services for a 12-month period commencing on the date of award.
All bidders must complete the disclosure form by indicating either "yes" or "no" in response to the conflict of interest question and must have the form signed by an authorized company representative, including their printed name and title. If a bidder answers affirmatively to the conflict of interest question, they must provide the name of the individual involved and their position held, and must notify the Office of County Counsel in writing with a copy attached to the form. Failure to sign the affidavit by a duly authorized company official may result in rejection of the proposal. The terms and definitions referenced in the form are construed in accordance with the Local Government Ethics Law.
View the file
Other files
Show all 12
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
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 .