3-FORM 1 - VENDOR CONFLICT OF INTEREST.pdf
PDF 270 KB Posted
- Solicitation number
- RFSQ-034-26-KM
- Issued by
- Leon County, Florida
About this file
This is a Vendor Conflict of Interest disclosure form for the City of Tallahassee, Florida, required as part of the solicitation for Pension and Non-Pension Investment Consultant Services - Fiduciary 3(21). The form requires vendors to disclose any current or reasonably foreseeable conflicts of interest involving the City of Tallahassee across six distinct categories. Vendors must respond to each statement with "Yes," "No," or "None Known," with affirmative responses requiring detailed explanations on separate attachments. The disclosure addresses employment relationships with current City employees or officials and their families, employment of former City public officials and managers, direct or indirect ownership interests by City employees or officials in the vendor, past or present payments or provisions of value to City employees or officials, unfair competitive advantages in relation to the contract opportunity, and potential conflicts between services provided to citizens and the vendor's affiliate or subsidiary activities. An authorized representative of the vendor must certify the accuracy and completeness of all information provided.
The form defines key terms including "Authorized Representative," "Relative," and "Material Personal Financial Interest," establishing that material financial interest includes ownership positions such as owner, proprietor, manager, partner, officer, director, shareholder, or beneficiary, with direct or indirect ownership of more than five percent of total assets or capital stock constituting a material interest. The form emphasizes that answering "Yes" does not necessarily disqualify a vendor, and the "None Known" option is available only when discovery is unduly burdensome due to workforce size or similar circumstances, requiring explanation of the burden. The authorized representative must sign and provide their printed name, position title, email address, and phone number as certification of the disclosure's truthfulness and completeness.
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Text version
5/2020
Vendor Conflict of Interest
Vendors are responsible for disclosing a current or reasonably foreseeable conflict of interest involving the City of Tallahassee. The City of Tallahassee seeks to avoid, neutralize, or mitigate significant potential or actual organizational conflicts of interest. Respond to each of the six statements in the boxes below. Answering “Yes” will not necessarily disqualify a Vendor.
Select “Yes” if a potential conflict of interests exists or if you are uncertain whether a particular circumstance constitutes a potential conflict of interest. If ‘Yes’ is selected, you must provide an explanation on a separate document and attach to this form.
Select “No” if a potential conflict of interest does not exist.
Select “None known” only if (a) it is unduly burdensome to discover the correct response for reasons such as your workforce is so large that it is unreasonable to ascertain whether any potential conflict of interest exists and (b) you in fact do not have knowledge of any potential conflict of interest. If None Known is selected, provide an explanation on a separate document and attach to this form. The explanation must describe why it is unduly burdensome to answer Yes or No.
Yes No None Known
Potential Conflict of Interest
1. Employment by Vendor of a current City of Tallahassee employee or public official, or their family.
2. Employment by Vendor of a former City of Tallahassee public official, manager, department director.
3. Direct or indirect ownership of material personal financial interest in Vendor by a City of Tallahassee employee, public official or their family.
4. A past, present, or foreseeable payment or provision of anything of value by Vendor to a City of Tallahassee employee, public official or their family that could reasonably appear to influence the employee’s or public official’s actions or judgement.
5. An unfair competitive advantage existing in favor of Vendor with regard to a City of Tallahassee contract for which Vendor is competing.
An unfair competitive advantage exists when the vendor competing for award of a contract obtained either (i) access to information that is
Vendor Conflict of Interest
RFP-111-25-KM
5/2020 not available to the public and which would assist the vendor in obtaining the contract or (ii) source selection information that is relevant to the contract but is not available to all competitors and that would assist the vendor in obtaining the contract.
6. Vendor, through any affiliates, subsidiaries, o other ongoing business relationships, has a potential or actual conflict between services that may be provided by Vendor to Citizens and the activities of the affiliate, subsidiary, or ongoing business relationship.
DEFINITIONS:
Authorized Representative means representative of the vendor with knowledge of vendor’s operations and personnel sufficient to in good faith provide potential conflict of interest information on behalf of the vendor as detailed above.
Relative means father, mother, son, daughter, husband, wife, brother, sister, father-in-law, mother-in-law, son-in-law or daughter-in-law, cousin, niece, nephew and step-children.
Material Personal Financial Interest in a vendor means any position as owner, proprietor, manager, partner (active or silent), officer, director, shareholder or beneficiary of such vendor. A material personal financial interest does not, in most instances, pertain to ownership of a limited number of shares in publicly held firms, shares owned through a mutual fund, or personal bank accounts.
However, direct or indirect ownership of more than five (5) percent of the total assets or capital stock of a vendor constitutes a material personal financial interest in such vendor.
SIGNATURE: By my signature below, I certify that I am an Authorized Representative of the Vendor named below, and that all of the information provided above is true and complete to the best of my knowledge:
Print Vendor Name Print Position Title
Print Your Name Email Address and Phone Number
Signature and Date
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