6-CONFLICT OF INTEREST STATEMENT FORM.pdf

This is a Conflict of Interest Statement Form required by Florida Statute 112.313 for vendors responding to a Marion County Solid Waste Department procurement for two grapple trailers. The form serves as a disclosure document to identify any potential conflicts of interest between respondents and County employees, public officers, or advisory board members. Respondents must disclose whether they are County employees or public officers, related to County personnel, have material interests in the respondent company, employ County officials, or are former County employees with less than one year of inactive service. The form requires respondents to certify their conflict status and indicate whether they will request an advisory board member waiver under Florida Statute 112.313(12). The Marion County procurement represents a re-advertisement of solicitation 26B-012, with the notable change that the bid bond requirement has been eliminated from the current iteration.

The Conflict of Interest Statement Form requires company identification, printed names, and signatures from authorized representatives. The form includes checkboxes for each conflict category and a separate section addressing advisory board member waivers. The County explicitly reserves the right to review any relationships that may be prohibited under the Florida Ethics Code and will disqualify any vendor whose conflicts are not waived or deemed exempt. Respondents must complete this disclosure concurrent with their proposal submission to ensure compliance with state ethics regulations and maintain procurement integrity.