5-G3. REQUIRED CONFLICT OF INTEREST DISCLOSURE.pdf
PDF 106 KB Posted
- Attached to
- COLLIER PARKWAY AT LIVINGSTON ROAD INTERSECTION IMPROVEMENTS State and local contract opportunity
- Solicitation number
- IFB-KM-26-005
- Issued by
- Pasco County, Florida
About this file
This document is a Conflict of Interest Disclosure form for a bid proposal with Pasco County, Florida. The form requires bidders to disclose any potential conflicts of interest, specifically mandating that bidders reveal the names of any officers, directors, or agents who are also Pasco County employees, as well as any Pasco County employees who own a 10% or greater interest in the bidding firm or its branches.
The second page of the document contains a certification statement where the bidder affirms, under penalty of perjury, that the bid proposal is made without prior understanding or agreement with other potential bidders, and is fair and free from collusion or fraud. The bidder must sign the document, providing their name, printed name, title, and the date, thereby agreeing to abide by all conditions of the bid proposal.
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Other files for this state and local contract opportunity
| File | Type | Posted |
|---|---|---|
| 13-I. POST AWARD DOCUMENTS.pdf | ||
| 16-E4. ACOE Permit.pdf | ||
| 3-E3. SWFWMD ERP.pdf | ||
| 4-G1. REQUIRED BID BOND.pdf | ||
| 11-E. PROJECT SPECIFIC SPECIAL CONDITIONS-SPECIAL PROVISIONS-TECH SPECS-PERMITS-REPORTS.X.pdf | ||
| 18-E5. Drainage Design Report.pdf | ||
| 6-G4. REQUIRED CERTIFICATION OF UNDERSTANDING.pdf | ||
| 7-D. SPECIAL CONDITIONS.pdf | ||
| 1-A. ADVERTISEMENT PAGE.pdf | ||
| 10-E2. Pasco County Testing Specifications 2006.pdf | ||
| 12-C. GENERAL CONDITIONS.pdf | ||
| 14-E7. B2 UWS.pdf | ||
| 9-H. AGREEMENT.pdf | ||
| 15-E6. Geotech Report.pdf | ||
| 17-E1. FINAL PLANS.pdf | ||
| 19-F. BID PROPOSAL-OFFEROR FORM.pdf | ||
| 2-B. INSTRUCTIONS TO BIDDERS.pdf | ||
| 8-G2. REQUIRED FLORIDA TRENCH SAFETY ACT CERTIFICATION AND DISCLOSURE STATEMENT.pdf |
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Text version
CONFLICT OF INTEREST DISCLOSURE
(MANDATORY)
The award hereunder is subject to provisions of Chapter 112, Florida Statutes. All BIDDERS must disclose with their Bid Proposal the name of any officer, director, or agent who is also an employee of Pasco County, Florida. Further, all BIDDERS must disclose the name of any Pasco County employee who owns, directly or indirectly, an interest of ten (10) percent or more in the BIDDER’S firm or any of its branches.
NAME CONFLICT
NOTE: Attach additional sheets if needed.
The undersigned, under penalty of perjury, claiming authority to act for the BIDDER named below, does hereby certify on behalf of the BIDDER that this Bid Proposal is made without prior understanding, agreement, or connection with any corporation, firm, or person submitting a Bid Proposal for the same WORK, MATERIALS, supplies, or EQUIPMENT; that it is in all respects fair and without collusion or fraud; and that the BIDDER agrees to abide by all conditions of this Bid Proposal.
NAME OF BIDDER
BY:
PRINTED NAME:
TITLE:
DATE:
| NAME: |
| undefined: |
| undefined_2: |
| undefined_3: |
| undefined_4: |
| undefined_5: |
| NAME OF BIDDER: |
| PRINTED NAME: |
| undefined_6: |
| undefined_7: |
File details come from the government source that posted it. Updated .