9-Vendors Conflict of Interest Form.pdf
PDF 155 KB Posted
- Attached to
- Progressive Design-Build Services for Town of Palm Beach Mid-Town Seawall Replacement Project
- Solicitation number
- RFQ No.2026-020
- Issued by
- Palm Beach County, Florida
About this file
This is a Conflict of Interest Statement form issued by the Town of Palm Beach Procurement and Contracts Management Division for vendors responding to the Progressive Design-Build Services solicitation for the Mid-Town Seawall Replacement Project in Palm Beach, Florida. The solicitation seeks a qualified firm to provide Design-Build services at a Guaranteed Maximum Price for the replacement of the existing Mid-Town Seawall, which spans approximately 2,700 linear feet along South Ocean Boulevard between Gulfstream Road and Royal Palm Way. The project encompasses work within the Town's right-of-way, Town-owned property, and areas seaward of the coastal construction control line. A mandatory pre-proposal meeting and site visit will be held on March 31, 2026, at 10:00 AM EST at the Public Works Building in West Palm Beach, with the site visit to follow at the Worth Avenue Clock Tower in Palm Beach. Failure to attend both the meeting and site visit will result in disqualification. Proposals must be submitted online through the EUNA Procurement platform, and vendors may not withdraw proposals for a period of one hundred and eighty days.
The Conflict of Interest Statement requires vendors to disclose any potential conflicts of interest in accordance with Town of Palm Beach ordinances, Palm Beach County Code of Ethics, and Florida Statutes Chapter 112, Part III. Vendors must certify whether they have no conflicts or submit information regarding potential conflicts, including any relationships with Town employees, elected officials, appointed officials, or ownership interests of five percent or greater held by such parties. The vendor's duty to disclose conflicts is continuing throughout the award term and any renewals or extensions, with vendors required to immediately notify the Town of any conflicts that arise.
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Text version
Town of Palm Beach
Procurement and Contracts Management Division
CONFLICT OF INTEREST STATEMENT
Solicitation No. _________________ Proposal from __________________
This solicitation/proposal (whichever is applicable) is subject to the conflict-of-interest provisions of the policies and Code of Ordinances of the Town of Palm Beach, the Palm Beach County Code of Ethics, and the Florida Statutes. During the term of this award and any renewals or extensions thereof, the VENDOR shall disclose to the Town of Palm Beach any possible conflicts of interest(s). The VENDOR’S duty to disclose is of a continuing nature and any conflict of interest shall be immediately brought to the attention of the Town of Palm Beach. The terms below shall be defined in accordance with the policies and Code of Ordinances of the Town of Palm Beach, the Palm Beach County Code of Ethics, and Ch. 112, Part III, Florida Statues.
CHECK ALL THAT APPLY
NO CONFLICT:
____ To the best of our knowledge, the undersigned business has no potential conflict of interest for this solicitation/proposal due to any other clients, contracts, or property interests.
____ To the best of our knowledge, the undersigned business has no employment or other contractual relationship with any Town of Palm Beach employee, elected official or appointed official.
____ To the best of our knowledge, the undersigned business has no officer, director, partner or proprietor that is a Town of Palm Beach purchasing agent, other employee, elected official or appointed official. The term “purchasing agent”, “elected official”, or “appointed official”, as used in this paragraph, shall include the respective individual’s spouse or child, as defined in Ch. 112, Part III of the Florida Statues.
___ To the best of our knowledge, no Town of Palm Beach employee, elected official or appointed official has a material or ownership interest of (5% or greater ownership) in our business.
POTENTIAL CONFLICT
___ The undersigned business, by attachment to this form, submits information which may be a potential conflict of interest due to any of the above listed reasons or otherwise.
Company __________________________________________________________
Authorized Signature _________________________________________________
Name (print or type) __________________________________________________
Title ______________________________________________________________
Date _______________________
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