Conflict of Interest and Public Entity Crime Affidavit 1.26.pdf

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Completed form must be submitted with bid response. Procurement & Contracting Department

PO Box 690519, Orlando, FL 32869

CONFLICT OF INTEREST &

PUBLIC ENTITY CRIME AFFIDAVIT

SOLICITATION INFORMATION

INVITATION #: __________ PROJECT TITLE: ___________________________________________________________

CONFLICT OF INTEREST POLICY

All respondents must list all and any affiliations they have with other bidders/proposers, or a shared ownership interest greater than 5% with any Central Florida Tourism Oversight District (“District”) staff, District-appointed officials, or contracted persons. After review of disclosure, employees of the District may be asked to complete a Conflict of Interest/Financial Interest Disclosure Statement.

Per Florida Statutes § 112.313 and 112.3143, Bidder hereby certifies that, to the best of its knowledge, no Central Florida Tourism Oversight District Board Supervisor, officer or employee, nor their spouse, child, father, mother, brother, sister, father-in-law, mother-in-law, son-in-law, daughter-in-law, or business associate, is an officer, director, partner, proprietor or employee of, or has any material interest in, the Bidder or will financially benefit from a contract between Bidder and the District.

Respondents must complete the below section, disclosing any and all conflicts of interest for the below referenced solicitation, if any.

If no conflict exists, check here ______.

CONFLICT OF INTEREST DISCLOSURE

Disclose the name(s) of any employee, officer, director, shareholder, or agent of your firm that is also a District employee or public official, (or) any District personnel who may financially benefit from a contract between Bidder and the District:

Disclose the name(s) of any District employee or public official that is a known relative of an employee, officer, director, shareholder, or agent of your firm:

Disclose the name(s) of other bidders/proposers your firm is affiliated with:

PUBLIC ENTITY CRIME RESTRICTIONS

A person or affiliate who has been placed on the convicted vendor list following a conviction for a public entity crime may not submit a bid, proposal, or reply on a contract to provide any goods or services to a public entity;

may not submit a bid, proposal, or reply on a contract with a public entity for the construction or repair of a public building or public work; may not submit bids, proposals, or replies on leases of real property to a public entity; may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity; and may not transact business with any public entity in excess of the threshold amount provided in Florida Statutes § 287.017 for CATEGORY TWO for a period of 36 months following the date of being placed on the convicted vendor list.

http://www.leg.state.fl.us/Statutes/index.cfm/Ch0499/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0287/Sections/0287.017.html http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0100-0199/0112/Sections/0112.313.html http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0100-0199/0112/Sections/0112.3143.html

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CONFLICT OF INTEREST &

PUBLIC ENTITY CRIME AFFIDAVIT

PUBLIC ENTITY CRIME DEFINITIONS

“Affiliate” means: (1.) A predecessor or successor of a person convicted of a public entity crime; or (2.) An entity under the control of any natural person who is active in the management of the entity and who has been convicted of a public entity crime. The term “affiliate” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in the management of an affiliate. The ownership by one person of shares constituting a controlling interest in another person, or a pooling of equipment or income among persons when not for fair market value under an arm’s length agreement, shall be a prima facie case that one person controls another person. A person who knowingly enters into a joint venture with a person who has been convicted of a public entity crime in Florida during the preceding 36 months shall be considered an affiliate.

“Convicted” or “conviction” means a finding of guilt or a conviction of a public entity crime, with or without an adjudication of guilt, in any federal or state trial court of record relating to charges brought by indictment or information after July 1, 1989, as a result of a jury verdict, nonjury trial, or entry of a plea of guilty or nolo contendere.

“Convicted vendor list” means the list required to be kept by the department pursuant to paragraph (3)(d) in Florida Statutes § 287.133.

“Person” means any natural person or any entity organized under the laws of any state or of the United States with the legal power to enter into a binding contract and which bids or applies to bid on contracts let by a public entity, or which otherwise transacts or applies to transact business with a public entity. The term “person” includes those officers, directors, executives, partners, shareholders, employees, members, and agents who are active in management of an entity.

“Public entity” means the State of Florida, any of its departments or agencies, or any political subdivision.

“Public entity crime” means a violation of any state or federal law by a person with respect to and directly related to the transaction of business with any public entity or with an agency or political subdivision of any other state or with the United States, including, but not limited to, any bid, proposal, reply, or contract for goods or services, any lease for real property, or any contract for the construction or repair of a public building or public work, involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation.

RESPONDENT – COMPANY NAME & SIGNATURE

I affirm neither the respondent (“entity”), nor any officers, directors, executives, partners, shareholders, employee, members or agents who are active in the management of the entity, nor any affiliate of the entity have been convicted of a public entity crime subsequent to July 1, 1989.

X

I affirm the information contained herein is accurate and understand a false statement may result in bid rejection, debarment and contract termination.

COMPANY NAME: ___________________________________________________________________________________

Respondent Signature: _______________________________________________ Date: _________________________ http://www.leg.state.fl.us/Statutes/index.cfm/Ch0499/index.cfm?App_mode=Display_Statute&Search_String=&URL=0200-0299/0287/Sections/0287.133.html