Conflict_of_Interest.pdf
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- Solicitation number
- PD 25-26.009
- Issued by
- Escambia County, Florida
About this file
This is a Conflict of Interest and Litigation Statement form required for submission by the Escambia County Board of County Commissioners in Florida for the Architectural and Engineering Services solicitation for the new Escambia County Animal Welfare Facility. Respondents must certify their conflict of interest status by selecting one of two options: either confirming no potential conflicts of interest due to other clients, contracts, or property interests, or disclosing potential conflicts by attachment to the form. Similarly, firms must declare their litigation history by certifying either no litigation or judgments against them by any local, state, or federal entity in the past ten years, or by submitting a summary and disposition of individual cases with litigation or judgments entered by or against any such entities during the specified period. The form requires the company name, authorized signature, printed name, and title of the signatory.
Failure to check the appropriate boxes or provide required documentation of potential conflicts of interest or litigation summaries may result in disqualification of the bid. This form is a mandatory compliance document that must be completed and submitted as part of the RFQ response for the 50,000 square-foot animal welfare facility project, with proposals due by December 2, 2025, at 10:30 am through the ProcureNow portal. The evaluation criteria weight litigation and claims at 20 points out of the total scoring rubric, underscoring the significance of this disclosure requirement in the selection process.
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Text version
CONFLICT/NON-CONFLICT OF INTEREST STATEMENT
CHECK ONE
[ ] To the best of our knowledge, the undersigned firm has no potential conflict of interest due to any other clients, contracts, or property interest for this project.
OR
[ ] The undersigned firm, by attachment to this form, submits information which may be a potential conflict of interest due to other clients, contracts, or property interest for this project.
LITIGATION STATEMENT
CHECK ONE
[ ] The undersigned firm has had no litigation and/or judgments entered against it by any local, state, or federal entity and has had no litigation and/or judgments entered against such entities during the past ten (10) years.
[ ] The undersigned firm, BY ATTACHMENT TO THIS FORM, submits a summary and disposition of individual cases of litigation and/or judgments entered by or against any local, state, or federal entity, by any state or federal court, during the past ten (10) years.
COMPANY NAME
AUTHORIZED SIGNATURE
NAME (PRINT OR TYPE)
TITLE
Failure to check the appropriate blocks above may result in disqualification of your bid. Likewise, failure to provide documentation of a possible conflict of interest, or a summary of past litigation and/or judgments, may result in disqualification of your bid.
CONFLICT/NON-CONFLICT OF INTEREST STATEMENT
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