Attachment_6_COI.pdf
PDF 85 KB Posted
- Attached to
- Water Cooler Filter Replacement -Term Contract
- Solicitation number
- 052-MJ-0425
- Issued by
- Polk County, Florida
About this file
The document is a Conflict of Interest Statement form for the Polk County School Board's Water Cooler Filter Replacement Term Contract, designed to be completed by potential bidders. The form requires proposers to disclose any contractual, business, or personal relationships that exist or have existed since 2020 between the proposing firm, its predecessors, subcontractors, and the Polk County School Board or any entities involved in the project. Bidders must transparently report any potential conflicts of interest, understanding that while not every relationship constitutes a conflict, failure to disclose may result in proposal disqualification.
The form provides a blank space for detailed disclosure and includes a checkbox option for firms with no existing relationships. The School Board retains final determination on whether a reported relationship represents a true conflict of interest. By requiring this comprehensive disclosure, the document aims to ensure transparency and ethical bidding practices for the water cooler filter replacement contract, which involves servicing approximately 1,900 Oasis water coolers and 500 water cooler bottle filler combo units throughout the district.
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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 of time 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 RFP, and the School Board of Polk County, Florida.
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 Representa�ve’s Signature Date
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