COI_EOA_PC_Fillable.pdf
PDF 76 KB Posted
- Solicitation number
- BPM053821
- Issued by
- Queen Anne's County, Maryland
About this file
This is a Conflict of Interest Disclosure, Employment of Aliens Statement, and Political Contribution Reporting Requirements form for Queen Anne's County, Maryland. The form applies to all vendors and bidders participating in the procurement process for professional well installation services at White Marsh Park, located at 200 Bloomfield Farm Lane, Centreville, Maryland. Sealed bids will be received by the County Commissioners of Queen Anne's County at the Department of Parks and Recreation, 1945 4H Park Road, Centreville, Maryland 21617, with a submission deadline of November 7, 2025, at 1:00 PM local time. Following the bid opening, bids will be opened publicly and read aloud, with contract award to the lowest responsive and responsible bidder.
The form requires bidders to disclose any actual or potential conflicts of interest involving themselves, their company, or their employees. Vendors must certify compliance with all applicable federal and state laws and regulations governing the employment of aliens, with non-compliance constituting a material breach of contract and subject to termination by the County. Additionally, any person doing business with the County may be subject to political contribution reporting requirements under Title XIV of the Maryland Election Law. Bidders must provide their signature, printed name, company or organization name, address, phone number, and date of submission on the form.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| WhiteMarshWell_ITB.pdf | ||
| Appendix_B_DraftSketchPlan.pdf | ||
| Addendum1.pdf | ||
| Revised Section I_Scope-of-Work.pdf | ||
| Well Installation Services Bid Doc.pdf | ||
| BidForm_Fillable_Well_Final.pdf |
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Text version
CONFLICT OF INTEREST DISCLOSURE EMPLOYMENT OF ALIENS STATEMENT POLITICAL
CONTRIBUTION REPORTING REQUIREMENTS FORM
In connection with the undersigned s participation in the bid process or request for proposals being considered by the County Commissioners of Queen Anne s County the County the undersigned does affirm under the penalties of perjury as follows
I have reviewed the materials provided by the County in connection with my proposed bid or proposal and reviewed such records of my company and business as necessary to make the following statements
Check all appropriate boxes o To the best of my knowledge and belief neither I the company identified below nor any employee of the company have been involved or are presently involved in any situations or actions that might be regarded as an actual or potential conflict of interest in the event of a successful bid or award o It appears that I the company identified below or an employee of the company have been involved in some situations or actions that might be regarded as a potential conflict of interest should I submit the successful bid or proposal Details of such situations and or actions are hereby attached to this form attach additional sheet s o The following situations or actions in which I my company or an employee of the company are presently involved might be regarded as a potential conflict of interest if I submit the successful bid or proposal attach additional sheet s o I have attached a list of all present contracts between the company named below and the
County
Furthermore vendors providing goods or services to Queen Anne s County Government as a condition of doing business with the County are required to comply with all applicable laws and regulations relating to the employment of aliens
Should vendors providing goods or services to Queen Anne s County fail to comply with applicable laws and regulations relating to the employment of aliens such failure shall constitute a material breach of the vendor s contractual relationship with Queen Anne s County and the County may take all reasonable steps to terminate the County s contractual relationship with the vendor If you have questions please consult the County Department that manages your vendor contract
Notice of reporting requirements Any person doing business with a government entity may be subject to the political contribution reporting requirements of Title XIVof the Election law Article of the
Annotated Code of Maryland
Signature Name please print
Company Organization
Address
Phone Number
Date
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| Check Box0: Off |
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| Check Box2: Off |
| Check Box3: Off |
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