Appendix_B_Conflict_of_Interest_Statement.docx
DOCX document 15 KB Posted
- Attached to
- Employee Benefits Consultant Services
- Solicitation number
- 023-DW-0125
- Issued by
- Polk County, Florida
About this file
The document is a Conflict of Interest Statement for the School Board of Polk County, Florida, related to a solicitation for Employee Benefits Consultant Services. The statement requires proposers to disclose any existing or past contractual, business, or personal relationships between the proposing firm, its subcontractors, principals, or affiliates, and the School Board of Polk County from 2020 to the present.
The contract opportunity seeks a qualified Employee Benefits Insurance Consulting firm to collaborate with the District in purchasing insurance products for its employees. The services are anticipated to be compensated on a fee-for-service basis, with the primary objective of identifying and promoting insurance products that best serve the interests of the District and its employees. Proposers must transparently report any potential conflicts of interest, with the understanding that failure to disclose such relationships may result in proposal disqualification, and the District retains final determination on conflict of interest matters.
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| 023-DW-0125_Withdrawal.pdf | ||
| Robinson_Bush_contract_FE_05.23.2024.pdf | ||
| 023-DW-0125_Employee_Benefits_Consultant_Services_Addendum1.pdf | ||
| Appendix_C_AD-1048_Cert_debar_susp_inelig_vol_excl.docx | DOCX document | |
| 023-DW-0125_Employee_Benefits_Consultant_Services_ITN.pdf | ||
| Appendix_F_Byrd_Antilobbying_Amendment.docx | DOCX document | |
| Appendix_E_MWBE-LDB-VBE_Form.docx | DOCX document | |
| Appendix_A_Statement_of_Affirmation_and_Intent.docx | DOCX document | |
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Text version
Appendix B Conflict of Interest Statement
In the space provided below, please disclose any contractual relationship that exists or has existed during any part of the period from year 2020 through the present between the proposer, or a predecessor organization of the proposer, or a subcontractor included in the proposer’s response to this solicitation, and the School Board of Polk County.
Also, in the space provided please disclose any existing business or personal relationship between the proposer, its principals, or any affiliate or subcontractor, and the District, or any other entity or person involved in the project that is the subject of this solicitation.
If no relationships as described above exist or have existed, please indicate this by placing a check mark in the box provided below.
Not every prior or existing relationship will constitute a conflict of interest. However, each such relationship must be disclosed. Proposer should not merely state the conclusion that no conflict of interest exists. Failure to disclose any such prior or existing contractual or personal relationship as described in this section may result in disqualification of the proposal. The District will make the final determination regarding the existence of a conflict of interest.
Disclosure Statement:
No relationships exist/have existed |_|
Name of Firm/Respondent (Typed)
Authorized Representative’s Signature Date
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