7-Form 2 - Statement of Conflict of Interest.pdf
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- Solicitation number
- 005-26-EPW-IFB
- Issued by
- Cameron County, Texas
About this file
This document is a Conflict of Interest Disclosure Form (Form 2) for the City of Brownsville, Texas Procurement Department, dated October 2025 for Fiscal Year 2026. The form requires vendors responding to solicitations to disclose any potential conflicts of interest related to goods or services being procured. Respondents must complete and submit a Texas Ethics Commission Form CIQ (Conflict of Interest Questionnaire) within the solicitation response, indicating either existing conflicts or marking "N/A" if no conflicts exist. If conflicts are present, a detailed mitigation plan must be included.
The form outlines specific requirements under Chapter 176 of the Texas Local Government Code, mandating that vendors file the completed Form CIQ with the City Secretary's Office within seven business days of becoming aware of a conflict. The document emphasizes that the completed form is a public record and failure to file can result in penalties, including potential disqualification from consideration for award. Vendors must certify their understanding of these requirements by signing the acknowledgment and certification sections, providing their company information, and committing to compliance with state ethics regulations.
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Text version
FY26 – Version 2 Procurement Department October 2025
Form 2 - Statement Of Conflicts Of Interest (If Any)
Conflict of Interest Disclosure Instructions
The Respondent vendor must describe any conflicts of interest related to the goods and/or services associated with this solicitation.
The Respondent shall complete and submit Form CIQ (Form 2) indicating any conflicts of interest for the service provider or key employees. If no conflicts exist, the Respondent must indicate “N/A” on the form and submit it as part of their response.
A conflict of interest statement is required if any conflicts exist, along with a detailed plan for mitigating the conflict(s).
The Entity reserves the sole discretion to determine whether a conflict disqualifies a firm and/or whether a conflict mitigation plan is acceptable.
Respondent Acknowledgment
By signing below, the Respondent certifies and acknowledges the following:
1. The Respondent has reviewed the requirements of Chapter 176, Texas Local Government Code, regarding conflict of interest disclosures.
2. The Respondent understands that a completed Texas Ethics Commission Form CIQ must be filed with the City Secretary’s Office of the City of Brownsville, Texas, within seven (7) business days after the Respondent becomes aware of a conflict.
3. The Respondent acknowledges that the completed Form CIQ is a public record and will be made available by the City Secretary in accordance with state law.
4. The Respondent understands that failure to file a required Form CIQ is a violation of state law and may result in penalties under Texas Local Government Code §176.006 and possible disqualification from consideration for award.
5. The Respondent shall submit this acknowledgment form as part of its solicitation response and attach a copy of the completed TEC Form CIQ, if applicable.
City Secretary Contact Information
City of Brownsville – Office of the City Secretary 1001 East Elizabeth Street, Brownsville, Texas 78520 Email: citysecretary@brownsvilletx.gov Phone: (956) 548-6000
FY26 – Version 2 Procurement Department October 2025
Certification
By signing below, the undersigned Respondent certifies that they have read and understood the requirements of Chapter 176, Texas Local Government Code, and that the appropriate Conflict of Interest Questionnaire (Form CIQ) has been filed or will be filed as required.
Signature: ____________________________________________
Printed Name: _________________________________________
Title: _________________________________________________
Date: ______________________
Company Name: ________________________________________
Phone: ______________________
Email: _________________________________________________
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