8-Attachment 6 Conflict of Interest.docx
DOCX document 20 KB Posted
- Solicitation number
- RFP-ED2602
- Issued by
- Milwaukee County, Mattoon Village, Wisconsin
About this file
This is a Conflict of Interest Stipulation form for vendors submitting proposals in response to a Request for Proposal (RFP) issued by Milwaukee County, Wisconsin for the acquisition and development of land at 4320 South 6th Street, Milwaukee, WI 53221. The form requires all 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 with the vendor's business. Vendors must answer either "YES" or "NO" to this disclosure question on the form.
If a vendor answers "YES" to the conflict of interest question, the vendor must provide detailed identification information including the name of the individual involved, that individual's position with Milwaukee County, and the nature of the business relationship. The form must be completed and signed by an authorized corporate representative, who must provide their printed name, signature, title, and date of execution. This stipulation serves as a mechanism for Milwaukee County to identify and evaluate potential conflicts of interest prior to contract award.
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Other files
| File | Type | Posted |
|---|---|---|
| 1-RFP 4320 S 6th St Final.pdf | ||
| 6-Attachment 4 Exceptions.docx | DOCX document | |
| 7-Attachment 5 Vendor Information Sheet.docx | DOCX document | |
| 5-Attachment 3 Sworn Statement of Proposer.docx | DOCX document | |
| 3-Attachment 1 Proprietary Info Disclosure Form.docx | DOCX document | |
| 2-ATTACHMENT A-D.pdf | ||
| 4-Attachment 2 EEOC Compliance.docx | DOCX document | |
| 9-Attachment 7 Certification re Debarment Suspension.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 .