5-REQ-0007862 Conflict of Interest Statement.docx

This is a Conflict of Interest Statement form issued by the Great Lakes Water Authority (GLWA) for Procurement Requisition 0007862, related to the Third-Party Design Review of the Screened Final Effluent Rehabilitation project in Michigan. The form requires vendors submitting proposals to disclose any actual or potential conflicts of interest relative to entities listed in the solicitation. Vendors must provide their name, vendor code, and a detailed description of any conflicts if they exist. The form also requires vendor authorization information, including the printed name, title, phone number, and signature of an authorized representative, along with the submission date.

This document serves as a conflict of interest disclosure requirement and does not contain information regarding pricing terms, contract duration, award dates, or other substantive project details. The form is a standard compliance document designed to ensure vendor transparency and integrity in the procurement process for the GLWA project.