5-002118.40 WHS CTAE RMA Conflict of Interest Disclosure Affidavit.pdf

119 KB Posted

Attached to
Woodstock HS CTAE RMA
Solicitation number
2026.RMA.13.01
Issued by
Cherokee County, Georgia

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This is a Conflict of Interest Disclosure Affidavit for the Woodstock HS CTAE RMA construction project administered by the Cherokee County School District in Georgia. The affidavit requires the authorized representative of the general contractor to disclose any familial relationships between contractor representatives and Cherokee County Board of Education employees, agents, or board members. The form also requires disclosure of any actual or potential conflicts of interest relating to kinship, ownership interests, other clients, other contracts, or other matters concerning the school district, the project, or any school district representative. A mandatory Pre-Proposal Conference and site visit are scheduled for 1:30 p.m. on Monday, April 13, 2026, at the Cherokee County School District Support Service Office located at 200 Mountain Brook Ct, Canton, Georgia 30115.

All conflict of interest disclosures must be made under oath and notarized. The affidavit requires the contractor's authorized representative to provide their printed name, title, firm name, address, and signature along with the notary public's certification. Contractors must list any exceptions to the conflict of interest statement with full explanations. This disclosure document is a standard requirement for competitive proposals submitted to the Cherokee County School District for the construction project.

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Woodstock HS CTAE RMA Cherokee County School District

2026.RMA.13.01

04.02.2026

Conflict of Interest Disclosure Affidavit 002118.40 - 1

SECTION 002118.40

CONFLICT OF INTEREST DISCLOSURE AFFIDAVIT

STATE OF _______________________

COUNTY OF _____________________

I HEREBY CERTIFY, UNDER OATH THAT:

I________________________________ (Printed Name), am the _______________________________ (Title) and I am the duly authorized representative of __________________________________ (General Contractor "GC") for purposes of this Affidavit, whose address is _______________________________________ (GC Address), and I possess the legal authority to make this Affidavit on behalf of myself and the GC, as follows:

A. The following employee(s), officer(s), or agent(s) of the GC (collectively, “GC Representative”) is/are related, by blood or marriage, to an employee, agent, or Board Member of the Cherokee County Board of Education (Collectively, “Owner Representative”), as indicated below. If none, list "None".

GC Representative Owner Representative Relation

B. Except as listed below under “EXCEPTIONS”, neither the GC nor any GC Representative has any conflicts of interest, whether real or potential, due to kinship, ownership, other clients, other contracts, interests, or otherwise concerning the Cherokee County Board of Education, the Project or any Owner Representative.

EXCEPTIONS (fully disclose and completely explain)

Wherefore, the foregoing disclosure is fully complete and true and may be relied upon by the Cherokee County Board of Education.

Signature: ____________________

Printed Name:_________________

Firm Name: ___________________

Woodstock HS CTAE RMA Cherokee County School District

2026.RMA.13.01

04.02.2026

Conflict of Interest Disclosure Affidavit 002118.40 - 2

Date: _______________________

Sworn to and subscribed for me this ______ day of _____________________, 20_____.

NOTARY PUBLIC (SEAL) / My Commission Expires:

END OF SECTION 002118.40

002118.40 CCSD - Conflict of Interest Disclosure Affidavit

STATE OF:
COUNTY OF:
I:
Title and I am the duly authorized representative of:
General Contractor GC for purposes of this Affidavit:
whose address is:
GC RepresentativeRow1:
Owner RepresentativeRow1:
RelationRow1:
GC RepresentativeRow2:
Owner RepresentativeRow2:
RelationRow2:
GC RepresentativeRow3:
Owner RepresentativeRow3:
RelationRow3:
GC RepresentativeRow4:
Owner RepresentativeRow4:
RelationRow4:
GC RepresentativeRow5:
Owner RepresentativeRow5:
RelationRow5:
Wherefore the foregoing disclosure is fully complete and true and may be relied upon by the:
Printed Name:
Firm Name:
Date:

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