4-4 Conflict of Interest Form.pdf

PDF 1 MB Posted

Attached to
Request for Proposals for Maintenance and Repair of Vertical Turbine Pumps
Solicitation number
RFP 26-0159
Issued by
Tarrant County, Arlington City, Texas

About this file

This is a Conflict of Interest Form associated with a Request for Proposals issued by the City of Arlington, Texas for the maintenance and repair of vertical turbine pumps. The solicitation seeks to establish a qualified vendor capable of providing both routine and emergency services, including complete pump remanufacture to original equipment manufacturer (OEM) tolerances when required. The City of Arlington encourages electronic submission of proposals and requires that any paper submissions be placed in sealed envelopes or packages labeled with the company name, solicitation number, and title. Late proposals will not be accepted. All solicitation notices and addendums are distributed exclusively through the Bonfire platform, and the City assumes no responsibility for notifications received through alternative means, which may result in incomplete specifications or non-compliant bids.

The Conflict of Interest Form serves as a required disclosure document for bidders participating in this procurement. Prospective vendors must complete and submit this form as part of their proposal package to ensure compliance with the City's conflict of interest policies and procurement regulations. This form is a standard requirement designed to verify that bidders have no undisclosed conflicts that would impair their ability to perform the contract impartially or create appearances of impropriety in the selection process.

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CITY OF ARLINGTON - OFFICE OF PROCUREMENT

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)

Pursuant to Chapter 176 of the Local Government Code, any person or agent of a person who contracts or seeks to contract for the sale or purchase of property, goods, or services with a local governmental entity (i.e. City of Arlington) must disclose in the Conflict of Interest Questionnaire Form “CIQ” the person’s affiliation or business relationship that might cause a conflict of interest with the local governmental entity. Updated Questionnaires must be filed in conformance with Chapter 176.

A copy of the Questionnaire Form CIQ is enclosed with the submittal documents. The form is also available at https://www.ethics.state.tx.us/forms/conflict/

NOTE: If you are not aware of a Conflict of Interest in any business relationship that you might have with the City, state the Proposer name in # 1, and use N/A in each of the areas on the form. However, a signature is required in the #7 box in all cases.

https://www.ethics.state.tx.us/forms/conflict/

Project Number: Page 2 of 3 Project Title:

CONFLICT OF INTEREST QUESTIONNAIRE (CIQ)
NOTE: If you are not aware of a Conflict of Interest in any business relationship that you might have with the City, state the Proposer name in # 1, and use N/A in each of the areas on the form. However, a signature is required in the #7 box in all ca...
Project Title:
lJ Nlame ot vendor who has b11siness retatianshipwiU1 locrl govemmemal Qnlity:
Name oi Officer:
w Describe each employment or busi11ess 1Nlaticmshp th 1 the VQndor 1named in Section 1 mai11tai11s wilh a corporation or o1her business Qn1i1y wi1h respect to wihich 1he local govemment officer serves as 11 offioer or directo or holds 11n ownership interest of ooo pefcent or more:
Text1:
Text2:
Text3:
Text4:
Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off
Check Box6: Off

File details come from the government source that posted it. Updated .