8-Attachment 6 Conflict of Interest.docx
DOCX document 20 KB Posted
- Solicitation number
- RFP-ED2601
- Issued by
- Milwaukee County, Mattoon Village, Wisconsin
About this file
This is a Conflict of Interest Stipulation form required by Milwaukee County, Wisconsin for all vendors submitting proposals in response to this Request for Proposal concerning the acquisition and development of land and the County Medical Examiner's Office Building at 933 West Highland Avenue, Milwaukee. The form requires vendors to disclose whether any Milwaukee County employee, agent, or representative, or an immediate family member of such individuals, holds an ownership, officer, employee, agent, or representative position within the vendor's business. Vendors must answer either yes or no to this disclosure question.
If vendors answer affirmatively to the conflict of interest question, they must provide detailed information identifying the individual by name, their position with Milwaukee County, and their specific relationship to the vendor's business. An authorized corporate representative must sign, date, and print their name and title on the completed Conflict of Interest Stipulation, certifying the accuracy of the disclosure. This stipulation serves as a mechanism to identify and manage potential conflicts of interest that could compromise the integrity of the procurement process.
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Other files
| File | Type | Posted |
|---|---|---|
| 4-Attachment 2 EEOC Compliance.docx | DOCX document | |
| 2-ATTACHMENT A-D.pdf | ||
| 7-Attachment 5 Vendor Information Sheet.docx | DOCX document | |
| 6-Attachment 4 Exceptions.docx | DOCX document | |
| 1-RFP Medical Examiner RFP-ED2601.pdf | ||
| 9-Attachment 7 Certification re Debarment Suspension.docx | DOCX document | |
| 5-Attachment 3 Sworn Statement of Proposer.docx | DOCX document | |
| 3-Attachment 1 Proprietary Info Disclosure Form.docx | DOCX document |
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Text version
ATTACHMENT 6
CONFLICT OF INTEREST STIPULATION
For purposes of determining a possible conflict of interest, all vendors submitting a proposal in response to this RFP must disclose if any Milwaukee County employee, agent or representative or an immediate family member of any Milwaukee County employee, agent or representative is also an owner, officer, employee, agent or representative of the business submitting the proposal.
Please answer below either YES or NO to the question of whether any Milwaukee County employee, agent or representative or immediate family member is also an owner, officer, employee, agent or representative of your business:
YES _______________
NO _______________
If the answer to the question above is YES, then identify the name of the individual, the individual’s position with Milwaukee County, and the individual’s relationship to your business:
Name _______________________________________________________________________
County Position________________________________________________________________
Business Relationship ___________________________________________________________
The appropriate corporate representative must sign and date this Conflict of Interest Stipulation below:
Printed Name __________________________________________________________________
Authorized Signature ___________________________________________________________
Title __________________________________________________________________________
Date __________________________________________________________________________
File details come from the government source that posted it. Updated .