Conflict_of_Interest_Disclosure.pdf
PDF 80 KB Posted
- Attached to
- West Sunset Lift Station
- Solicitation number
- ITB WS 79-26
- Issued by
- Okaloosa County, Florida
About this file
This is a Conflict of Interest Disclosure form required by the Okaloosa Board of County Commissioners in Florida for the West Sunset Lift Station project. The form mandates that all bidders disclose any potential conflicts of interest involving Okaloosa County commissioners, employees, elected officials, or county agencies who may have ownership stakes, corporate officer positions, or other business associations with the bidder's firm. Bidders must indicate whether such conflicts exist by marking either "YES" or "NO" on the form and provide detailed information including the names, positions, and business affiliations of any conflicted parties if applicable.
The disclosure form requires bidders to complete all required fields including their firm name, address, title, email, office number, and cell number, with signature and printed name authentication. This conflict of interest documentation is a standard procedural requirement designed to ensure transparency and prevent improper business relationships between county officials or employees and contractors bidding on the project to furnish and install a tremie style wetwell along with pumps and electrical systems to replace the existing lift station.
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Text version
For purposes of determining any possible conflict of interest, all BIDDERs, must disclose if any Okaloosa Board of County commissioner, employee(s), elected official(s) or if any of its agencies is also an owner, corporate officer, agency, employee, etc., of their business.
Indicate either “YES” (a county employee, elected official or agency is also associated with your business) or “NO”. If yes, give person(s) name(s) and position(s) with your business.
YES: _______________ NO: _______________
NAME POSITION
Date By (Signature)
Firm Name By (Print)
Address Title
Address Email
Office Number Cell Number
DOCUMENT 00410-CONFLICT OF INTEREST DISCLOSURE
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