Conflict of Interest and Public Entity Crime Affidavit 1.26.pdf
PDF 627 KB Posted
- Attached to
- Rapid Infiltration Basins (RIBS) Rehabilitation: Three-Year Phasing State and local contract opportunity
- Solicitation number
- 145460
- Issued by
- Osceola County, Florida
About this file
This is a Conflict of Interest and Public Entity Crime Affidavit form required by the Central Florida Tourism Oversight District for submission with bid responses to the Rapid Infiltration Basins (RIBS) Rehabilitation: Three-Year Phasing solicitation. The form mandates that all respondents disclose any affiliations with other bidders or proposers, as well as any shared ownership interests greater than 5 percent with District staff, appointed officials, or contracted persons. Bidders must certify that no District Board Supervisor, officer, employee, or their immediate family members and business associates hold any officer, director, partner, proprietor, or employee positions in the bidding entity, nor will they financially benefit from a contract award. The affidavit requires comprehensive disclosure of any conflicts of interest, including the names of firm employees, officers, directors, shareholders, or agents who are also District employees or public officials, as well as identification of any District personnel who are known relatives of bidding firm personnel or any other bidders with which the firm is affiliated.
The form further establishes public entity crime restrictions prohibiting convicted vendors from submitting bids or proposals to public entities for a period of 36 months following placement on the convicted vendor list. Respondents must affirm under penalty of bid rejection, debarment, and contract termination that neither the entity nor any of its officers, directors, executives, partners, shareholders, employees, members, agents active in management, nor any affiliates have been convicted of a public entity crime subsequent to July 1, 1989. Public entity crimes include violations of state or federal law related to business transactions with public entities involving antitrust, fraud, theft, bribery, collusion, racketeering, conspiracy, or material misrepresentation. The completed affidavit must be submitted with all bid responses to the Central Florida Tourism Oversight District's Procurement and Contracting Department.
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Text version
Page 1 of 2 v. 1.26
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
Page 2 of 2 v. 1.26
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
| INVITATION: |
| PROJECT TITLE: |
| employee or public official: |
| director shareholder or agent of your firm: |
| Disclose the names of other biddersproposers your firm is affiliated with: |
| COMPANY NAME: |
| Check Box1: Off |
| Date_af_date: |
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