6-Conflict of Interest Form- Fillable PDF.pdf
PDF 98 KB Posted
- Attached to
- Public Relations and Outreach Services
- Solicitation number
- RFP HD-008 PR Outreach
- Issued by
- Alameda County, California
About this file
This is a Conflict of Interest Certification form issued by the Housing Authority of the City of Alameda (AHA) for bidders, proposers, and vendors responding to a Public Relations and Outreach Services contract opportunity in California. The form requires respondents to disclose any current or prior personal relationships with AHA officials, officers, employees, or their immediate family members or business associates; any current or prior business or financial relationships with AHA personnel or their associates; any other current or prior relationships with AHA personnel or associates; and any actual or apparent organizational conflicts of interest relating to the work to be performed. Additionally, respondents must identify any other projects they are currently working on in the City of Alameda. The certification requires the bidder or proposer to provide their organization name and address, the name and title of an authorized official or representative, the name of the primary contact at AHA or relevant project name, and a signature attesting under penalties of perjury that no conflict of interest exists.
The form serves as a compliance and disclosure mechanism to ensure procurement integrity and prevent conflicts that could compromise the Housing Authority's selection process or contract performance. Completion and submission of this certification form is a required submission component for all bidders responding to the Public Relations and Outreach Services solicitation. The form does not contain pricing information, set-asides, incumbent information, or funding details, as it functions solely as a conflict of interest disclosure and certification document rather than a substantive scope of work or solicitation document.
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Text version
HOUSING AUTHORITY OF THE CITY OF ALAMEDA CONFLICT OF
INTEREST CERTIFICATION
(a) Does the Bidder/Proposer/Vendor have any current or prior personal relationships with AHA current or former official, officer or employee or their immediate family member or business associate to disclose?*
(b) Does the Bidder/Proposer/Vendor have any current or prior business or financial relationships with AHA current or former official, officer or employee or their immediate family member or business associate to disclose?*
(c) Does Bidder/Propose/Vendor have any current or prior relationship with AHA current or former official, officer or employee or their immediate family member or business associate to disclose?*
(d) Is there an organizational conflict of interest, whether actual or apparent that the Bidder/Proposer/Vendor is aware of, or there is reason to be aware of, at the time of this submittal concerning any past, present, or currently planned interest, financial, contractual, organizational, or otherwise, relating to the work to be performed hereunder?*
Additional projects in the City of Alameda*
Name of Bidder/Proposer/Vendor*
Yes No
Yes No
Yes No
Yes No
Please list any other projects you are currently working on in the City of Alameda.
7/10/26, 4:03 PM New Submission https://form.alamedahsg.org/Forms/A4Gpo 1/2
Address of Bidder/Proposer/Vendor*
Name of Authorized Official or Representative of Bidder/Proposer/Vendor*
Title of Authorized Official or Representative of Bidder/Proposer/Vendor*
Name of primary contact at AHA and/or project name*
Signature*
City State / Province / Region
Postal / Zip Code Country
Street Address
Address Line 2
The undersigned Bidder/Proposer/Vendor hereby certifies and affirms under penalties of perjury, that to the best of this Bidder/Proposer/Vendor’s knowledge and belief, no actual or apparent conflict of interest exists as to the award of the contract to Bidder/Proposer/Vendor and to the performance of contract services by Bidder/Proposer/Vendor as described in Parts I, II, and III of Part A of the certification. The undersigned official certifies that he/she is authorized to sign this bids/proposals form for the firm.
7/10/26, 4:03 PM New Submission https://form.alamedahsg.org/Forms/A4Gpo 2/2
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