4-00 35 13 Conflict of Interest Statement.doc

This is a Conflict of Interest Statement form required by the City of Fort Worth for the 2027 Asphalt Resurfacing Contract 6 (City Project No. 106821). Each bidder, offeror, or respondent must complete a Conflict of Interest Questionnaire (CIQ) or certify that one is current and on file with the City Secretary's Office in accordance with state law. Additionally, a Local Government Officer Conflicts Disclosure Statement (CIS) may be required if any member of the Fort Worth City Council, City Manager, Assistant City Manager, or other City agent exercising discretion in planning, recommending, selecting, or contracting with the bidder is affiliated with the bidding company. The project involves approximately 2,710 linear feet of 7-inch curb and gutter, 15,221 square feet of 6-inch concrete driveway, 17,248 square feet of 4-inch concrete sidewalk, 50,465 square yards of 2-inch asphalt pavement (Superpave SP-D) with 50,465 square yards of surface milling, 15,635 square yards of 3-inch asphalt pavement (Superpave SP-D) with 15,635 square yards of pavement pulverization, 253 tons of cemlime, and 76 barrier-free ADA ramps. The document was revised June 5, 2026.

Bidders are required to certify their conflict of interest status by selecting the appropriate checkbox options indicating whether the CIQ form does not apply, is on file with the City Secretary, or is being provided to the City Secretary, and similarly for the CIS form. Bidders are urged to consult with legal counsel regarding the applicability of these forms and Local Government Code Chapter 176 to their company. The statement must be executed by an authorized representative of the bidding company with a signature, name, and title.