Conflict of Interest (8).pdf
PDF 60 KB Posted
- Attached to
- SHELTER AND GUARD/GATE HOUSE WRAP PROJECT
- Solicitation number
- 147452
- Issued by
- Marion County, Indiana
About this file
This is a Conflict of Interest Form required by the Indiana Airport Authority (IAA) for proposers submitting bids on the Shelter and Guard/Gate House Wrap Project in Indiana. The form mandates that all proposers complete either Section I or Section II, and Section III if applicable, and submit the executed form as Exhibit I with their proposal. Failure to properly disclose and complete the applicable sections may result in proposal rejection. The form serves as a certification mechanism for identifying any financial interests that IAA officials or employees may hold in the proposing company.
Section I requires proposers to certify that no IAA official or employee has any financial interest in the company. Section II requires disclosure of any IAA officials or employees who do have financial interests in the proposing company, with detailed identifying information required. Section III mandates that any public official with a financial interest in a proposal or contract must make a disclosure at the time of proposal submission or when the financial interest is acquired, with additional forms required if multiple public officials are involved. The form requests standard information including the public official's name, position, relationship to the proposer, and signatures from both the proposer and the public official.
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Text version
Conflict of Interest Form
Company Name:
Proposers must complete either Section I or Section II, and, if applicable, Section IIII, and submit this Exhibit I with the proposal. Failure to disclose and/or execute applicable sections may result in rejection of a proposal.
Section I
I hereby certify that no official or employee of the IAA requiring the goods or services described in these specifications has any financial interest in this company. Please print or type the following:
Name Title or Position Date
Signature Company Name
Name of Official Business Address
City State Zip Country
Section II
I hereby certify that the following named IAA official(s) and/or employees(s) has/have a financial interest(s)in this company. Please print or type the following:
Name Title or Position Date
Signature Company Name
Name of Official Business Address
City State Zip Country
Section Ill
The IAA requires that a public official who has a financial interest in a proposal or contract make a disclosure at the time that the proposal or contract is submitted or at the time that the public official acquires a financial interest in the proposal or contract. Please provide disclosure, if applicable with proposal. In the event there is more than one (1) Public Official, please use additional Forms.
Public Official’s Name Position
Relationship to Proposer Signature of Proposer
File details come from the government source that posted it. Updated .