Conflict of Interest.docx
DOCX document 16 KB Posted
- Attached to
- CEI Continuing Professional Services
- Solicitation number
- RFP 360 2026053 2
- 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 services on county projects. The form establishes the framework for disclosure and management of potential conflicts of interest in accordance with Chapter 112, Part III of the Florida Statutes and Section 2-441 et seq. of the Palm Beach County Code of Ethics. Consultants must disclose all current direct and indirect interests that could conflict with their performance of services for the county and certify that no conflicted personnel will be employed for the work. The form requires disclosure of the project name and number, with space provided for detailed description of any existing conflicts of interest that may influence the consultant's judgment or service quality.
The form establishes an ongoing obligation for consultants to promptly notify the county in writing via certified mail of any prospective business associations, interests, or circumstances that may arise during the contract period and could create conflicts of interest. Consultants must request the county's written opinion on whether such prospective interests would constitute unacceptable conflicts, and are prohibited from entering into any association or circumstance that the county determines would be an unacceptable conflict. The consultant certifies under penalty that all information provided is true and accurate, and acknowledges that any misrepresentation on the disclosure form constitutes unethical business practice and grounds for sanctions against future county business opportunities.
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Other files
| File | Type | Posted |
|---|---|---|
| Qualification Questionnaire Prime.docx | DOCX document | |
| Prime Firms SBE Past Participation Statement.docx | DOCX document | |
| Commercial Non-discrimination.docx | DOCX document | |
| 2026053 - CCNA RFP Package - signed.pdf | ||
| Qualification Questionnaire Prime.pdf | ||
| RFI Form.pdf | ||
| Conflict of Interest.pdf | ||
| RFI Form.docx | DOCX document | |
| OSBD Schedules and Instructions.pdf | ||
| Alternate Format Availability.pdf | ||
| Qualification Questionnaire Subconsultant.docx | DOCX document | |
| Commercial Non-discrimination.pdf | ||
| Instructions for Completing a CCNA RFP.pdf | ||
| Qualification Questionnaire Subconsultant.pdf | ||
| Prime Firms SBE Past Participation Statement.pdf | ||
| 2026053 Pre Proposal Sign In Sheet.pdf | ||
| Disclosure of Ownership Interests.docx | DOCX document |
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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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