Attachment_D_Conflict.Non-Conflict_of_Interest_Statement.pdf
PDF 166 KB Posted
- Attached to
- Body Shop Repairs
- Solicitation number
- ITB 0029-24
- Issued by
- Lee County, Fort Lauderdale City, Florida
About this file
Attachment D is a Conflict/Non-Conflict of Interest Statement form for the City of Fort Myers' Fleet Auto Body Repair contract opportunity in Florida. The document requires potential respondents to disclose any potential conflicts of interest or past litigation history by checking appropriate boxes and providing additional documentation if necessary. Respondents must indicate whether they have any conflicts due to other clients, contracts, or property interests, and must also declare their litigation history with local, state, or federal entities over the past seven years.
The form emphasizes the importance of complete and accurate disclosure, warning that failure to properly check the appropriate blocks or provide required documentation may result in disqualification of the proposal. The form provides two options for both conflict of interest and litigation statements: either declaring no conflicts/litigation or submitting detailed information about potential conflicts or past legal proceedings. The document is designed to ensure transparency and integrity in the bidding process for the fleet auto body repair contract.
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Text version
ATTACHMENT D
CONFLICT/NON-CONFLICT OF INTEREST STATEMENT
CHECK ONE
☐ To the best of our knowledge, the undersigned Respondent has no potential conflict of interest due to any other clients, contracts, or property interest for this project.
OR
☐ The undersigned Respondent, by attachment to this form, submits information which may be a potential conflict of interest due to other clients, contracts, or property interest for this project.
LITIGATION STATEMENT
CHECK ONE
☐ The undersigned Respondent has had no litigation and/or judgments entered against it by any local, state or federal entity and has had no litigation and/or judgments entered against such entities during the past seven (7) years.
OR
☐ The undersigned Respondent, BY ATTACHMENT TO THIS FORM, submits a summary and disposition of individual cases of litigation and/or judgments entered by or against any local, state or federal entity, by any state or federal court, during the past seven (7) years. This will not disqualify any Respondent automatically.
COMPANY NAME AUTHORIZED SIGNATURE
NAME (PRINT OR TYPE) TITLE
Failure to check the appropriate blocks above may result in disqualification of your submittal. Likewise, failure to provide documentation of a possible conflict of interest, or a summary of past litigation and/or judgments, may result in disqualification of your proposal.
File details come from the government source that posted it. Updated .