Conflict of Interest.docx
DOCX document 16 KB Posted
- Attached to
- CEI Continuing Professional Services
- Solicitation number
- RFP 360 2026053 1
- Issued by
- Palm Beach County, Florida
About this file
This is a Conflict of Interest Disclosure Form required by Palm Beach County, Florida for consultants and annual consultants providing professional services. The form serves as a standardized document for the CEI Continuing Professional Services contract opportunity and ensures compliance with Florida Statutes Chapter 112, Part III, and the Palm Beach County Code of Ethics under Section 2-441 et seq. Consultants must disclose any current direct or indirect interests that could conflict with service performance and certify that no conflicted individuals will be employed on the project. The form requires identification of the project name, project number, consultant name, title, and firm affiliation.
Consultants are obligated to notify Palm Beach County in writing via certified mail of any prospective business associations, interests, or circumstances that may arise during the contract term and could influence judgment or service quality. The County retains sole discretion to determine whether proposed associations constitute unacceptable conflicts of interest, and consultants are prohibited from pursuing any associations deemed unacceptable by the County. Misrepresentation on the disclosure form is considered an unethical business practice and grounds for sanctions against future County business relationships. The consultant must sign and date the form, certifying that all information provided is true and accurate and represents all current potential conflicts of interest.
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| Conflict of Interest.pdf | ||
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| RFI Form.docx | DOCX document | |
| Qualification Questionnaire Subconsultant.pdf | ||
| Disclosure of Ownership Interests.docx | DOCX document | |
| Commercial Non-discrimination.pdf | ||
| 2026053 - CCNA RFP Package - signed.pdf | ||
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| Alternate Format Availability.pdf | ||
| Prime Firms SBE Past Participation Statement.docx | DOCX document | |
| Qualification Questionnaire Prime.pdf | ||
| Instructions for Completing a CCNA RFP.pdf | ||
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Text version
CONFLICT OF INTEREST DISCLOSURE FORM
Project: ______________________________________________________
Project No.: _____________
CONSULTANT/ANNUAL CONSULTANT represents that it presently has no interest, either direct or indirect, which would or could conflict in any manner with the performance of services for the County, except as follows:
(Attach additional sheets as needed)
CONSULTANT/ANNUAL CONSULTANT further represents that it presently has no interest and shall acquire no interest which would conflict with performance of services solicited herein, as provided for in Chapter 112, Part III, Florida Statutes, and Section 2-441, et seq., the Palm Beach County Code of Ethics. The CONSULTANT/ANNUAL CONSULTANT further represents that no person having any such conflict of interest shall be employed for said performance of services.
CONSULTANT/ANNUAL CONSULTANT shall promptly notify the COUNTY in writing by certified mail of all potential conflicts of interest that may arise in the future through any prospective business association, interest or other circumstance which may influence or appear to influence CONSULTANT’S/ANNUAL CONSULTANT’S judgment or quality of services being provided to the County. Such written notification shall identify the prospective business association, interest or circumstance, the nature of work that CONSULTANT/ANNUAL CONSULTANT may undertake and request an opinion of the COUNTY as to whether the association, interest or circumstance would, in the opinion of the COUNTY, constitute an unacceptable conflict of interest if entered into by the CONSULTANT/ANNUAL CONSULTANT.
If, in the sole opinion of the COUNTY, the prospective business association, interest or circumstance of CONSULTANT/ANNUAL CONSULTANT would constitute an unacceptable conflict of interest to the COUNTY, the COUNTY shall so state in the notification and the CONSULTANT/ANNUAL CONSULTANT shall not enter into said association, interest or circumstance.
By signing below, CONSULTANT/ANNUAL CONSULTANT certifies that the information contained herein is true and correct and constitutes all current potential conflicts of interest which may influence or appear to influence CONSULTANT’S/ANNUAL CONSULTANT’S judgment or quality of services being provided to the County.
THIS DISCLOSURE is submitted by ________________________________________(name), as ____________________(title), of _____________________________________________(firm).
who hereby certifies that the information stated above is true and correct. Further, it is hereby acknowledged that any misrepresentation by the CONSULTANT/ANNUAL CONSULTANT on this Disclosure is considered an unethical business practice and is grounds for sanctions against future County business with the CONSULTANT/ANNUAL CONSULTANT.
| ____________________________ | ___________________________________ | ____________ | |
| (Print Name and Title) | (Signature) | (Date) |
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