Attachment 6 to RFP PB 18-5 - Disclosure of Ownership Interests.pdf
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- Attached to
- RFP PB-18-5 Common Use Airport Lounge PBIA
- Solicitation number
- RFP 120 DOA RFP PB-18-5 4
- Issued by
- Palm Beach County, Florida
About this file
This is a Disclosure of Ownership Interests attachment to RFP PB-18-5 for a Common Use Airport Lounge at Palm Beach International Airport (PBIA) in Florida. The document functions as a required disclosure form that bidders must complete as part of their proposal submissions, establishing transparency regarding the ownership structure and financial interests of participating companies. The form requires detailed information about all entities with ownership interests in the bidding organization, including the names, addresses, and percentage ownership stakes of all owners, whether direct or indirect. Bidders must disclose all principals, partners, shareholders, and other beneficial owners to ensure compliance with procurement regulations and to prevent conflicts of interest or undisclosed affiliations that could impact contract award decisions.
The disclosure requirements apply to all bidders regardless of their business structure—whether they are sole proprietorships, partnerships, corporations, or other entity types—and serve as a mandatory component of bid evaluation and due diligence. Failure to provide complete and accurate ownership information may result in bid rejection or disqualification from the procurement process. This attachment is integral to the airport's vetting procedures to ensure that all awarded contractors meet the jurisdictional requirements for transparency and that no prohibited or problematic ownership interests exist that would preclude contract award.
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Text version
ATTACHMENT “5”
COMMON USE AIRPORT LOUNGE CONCESSION AGREEMENT
PALM BEACH INTERNATIONAL AIRPORT
(RFP NO. PB 18-5)
Disclosure of Ownership Interests
RFP NO. PB 18-5 Page 1 of 2
TO: PALM BEACH COUNTY CHIEF OFFICER,
OR HIS OR HER OFFICIALLY DESIGNATED REPRESENTATIVE
STATE OF
COUNTY OF
BEFORE ME, the undersigned authority, this day personally appeared ______________________________________, hereinafter referred to as “Affiant,” who being by me first duly sworn, under oath, deposes and states as follows:
1. Affiant appears herein as:
[ ] an individual or [ ] the ________________________ of ____________________________________.
[position—e.g., sole proprietor, president, partner, etc.] [name & type of entity—e.g., ABC Corp., XYZ Ltd. Partnership, etc.].
The Affiant or the entity the Affiant represents herein seeks to do business with Palm Beach County through its Board of County Commissioners.
2. Affiant’s address is: __________________________________________________________________________
3. Attached hereto as Exhibit “A” is a complete listing of the names and addresses of every person or entity having a five percent (5%) or greater interest in the Affiant’s corporation, partnership, or other principal. Disclosure does not apply to nonprofit corporations, government agencies, or to an individual’s or entity’s interest in any entity registered with the Federal Securities Exchange Commission or registered pursuant to Chapter 517, Florida Statutes, whose interest is for sale to the general public.
4. Affiant acknowledges that this Affidavit is given to comply with Palm Beach County policy, and will be relied upon by Palm Beach County and the Board of County Commissioners. Affiant further acknowledges that he or she is authorized to execute this document on behalf of the entity identified in paragraph one, if any.
5. Affiant further states that Affiant is familiar with the nature of an oath and with the penalties provided by the laws of the State of Florida for falsely swearing to statements under oath.
6. Under penalty of perjury, Affiant declares that Affiant has examined this Affidavit and to the best of Affiant’s knowledge and belief it is true, correct and complete.
FURTHER AFFIANT SAYETH NAUGHT.
_______________________________, Affiant (Print Affiant Name)
The foregoing instrument was acknowledged before me this ____ day of ___________, 20____, by _______________________________, [ ] who is personally known to me or [ ] who has produced ___________________________________ as identification and who did take an oath.
Notary Public (Print Notary Name) State of at Large My Commission Expires: ________________
ATTACHMENT “5”
COMMON USE AIRPORT LOUNGE CONCESSION AGREEMENT
PALM BEACH INTERNATIONAL AIRPORT
(RFP NO. PB 18-5)
Disclosure of Ownership Interests
RFP NO. PB 18-5 Page 2 of 2
EXHIBIT “A”
Affiant must identify all entities and individuals owning five percent (5%) or more ownership interest in Affiant’s corporation, partnership or other principal, if any. Affiant must identify individual owners. For example, if Affiant’s principal is wholly or partially owned by another entity, such as a corporation, Affiant must identify the other entity, its address, and the individual owners of the other entity. Disclosure does not apply to any nonprofit corporation, government agency, or to an individual’s or entity’s interest in any entity registered with the Federal Securities Exchange Commission or registered pursuant to Chapter 517, Florida Statutes, whose interest is for sale to the general public.
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