ATTACHMENT B CONFLICT OF INTEREST ACKNOWLEDGEMENT AND CERTIFICATION FORM.pdf
PDF 245 KB Posted
- Attached to
- Lubricants and Fluid Supply
- Solicitation number
- 145235
- Issued by
- Nueces County, Texas
About this file
This Conflict of Interest Acknowledgement and Certification Form is required documentation for bidders participating in the Lubricants and Fluid Supply contract opportunity with the Capital City Regional Transportation Authority (CCRTA) in Texas. The contract is a two-year fixed price supply agreement with economic price adjustment provisions, effective December 12, 2026. CCRTA will award a single contract to the lowest responsive and responsible bidder whose proposal demonstrates best overall value and capability to supply the majority or all required filters. Bidders must submit Specification Information/Data Sheets for each brand and type of lubricant or fluid proposed, along with corresponding Safety Data Sheets (SDS), as part of their bid submission. Failure to provide this supplemental documentation may result in the bid being deemed non-responsive.
Compliance documentation is mandatory for specific fluid categories, including Cummins compliance documentation for Natural Gas Engine Oil as outlined in Section 3.0 of the Technical Specifications, Cummins compliance documentation for Engine Coolant/Antifreeze per Section 4.0, and Allison Transmission compliance documentation for Transmission Fluid per Section 6.0 of the Technical Specifications. This conflict of interest certification form ensures bidder integrity and compliance with procurement standards throughout the evaluation and award process.
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Text version
IFB No. 2026-SP-14 Lubricants and Fluid Supply
ATTACHMENT B
CONFLICT OF INTEREST ACKNOWLEDGEMENT
AND CERTIFICATION FORM
1. The Contractor represents that no officer or employee of the CCRTA has a Substantial Interest (defined as any interest which has a value of $5,000.00 or more or represents ten percent (10%) or more of a person's gross income during the most recent calendar year) in this Contract.
The Contractor further represents that no officer or employee of the CCRTA has (1) colluded with the Contractor in a recommendation for award, bid, proposal or solicitation on any CCRTA contracts, or (2) received any pecuniary benefit from the Contractor within the past six months.
2. The Contractor agrees to ensure that the CCRTA’s Code of Ethics is not violated as a result of the Contractor’s activities in connection with this Contract. The Contractor agrees to immediately inform the CCRTA if it becomes aware of the existence of any such Substantial Interest or Conflict of Interest, or the existence of any violation of the Code of Ethics arising out of or in connection with this Contract.
3. The CCRTA may in its sole discretion, require the Contractor to cause an immediate divestiture of such Substantial Interest or elimination of such Conflict of Interest, and failure by the Contractor to comply shall render this Contract voidable by the CCRTA. Any willful violation of these provisions, creation of a Substantial Interest or existence of a Conflict of Interest with the express or implied knowledge by the Contractor shall render this Contract voidable by CCRTA.
4. In accordance with section 176.006, Texas Local Government Code, the Contractor is required to file a Conflict-of-Interest Questionnaire (CIQ) within seven business days of becoming aware of a Conflict of Interest under Texas law. The CIQ can be obtained from the Texas Ethics Commission at www.ethics.state.tx.us. The CIQ shall be sent to CCRTA’s Director of Procurement or its designee.
I DO CERTIFY THAT THE CONTENTS OF THIS ACKNOWLEDGEMENT AND CERTIFICATION
ARE TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF.
Company Name
Certifying Person (Print or Type) Signature of Certifying Person
Title
Date http://www.ethics.state.tx.us/
| ATTACHMENT B |
| CONFLICT OF INTEREST ACKNOWLEDGEMENT |
| AND CERTIFICATION FORM |
| Company Name: |
| Certifying Person Print or Type: |
| Title: |
| Date: |
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