Conflict of Interest.pdf
PDF 179 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 for Palm Beach County, Florida, required for consultants and annual consultants performing services for the county on the CEI Continuing Professional Services contract. The form requires consultants to disclose any existing direct or indirect interests that could conflict with service performance and to certify compliance with Chapter 112, Part III of Florida Statutes and Section 2-441 et seq. of the Palm Beach County Code of Ethics. Consultants must represent that no employees assigned to the work have conflicting interests and must promptly notify the county in writing of any prospective business associations, interests, or circumstances that could influence judgment or service quality.
The form requires the consultant to request the county's opinion on whether identified prospective business activities would constitute an unacceptable conflict of interest, and the consultant is prohibited from entering into any activity the county deems conflicting. The disclosure must be signed and certified as true and correct by the consultant representative with authority to execute the document. The form emphasizes that misrepresentation constitutes unethical business practice and grounds for sanctions on future county business with the consultant.
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Other files
| File | Type | Posted |
|---|---|---|
| Qualification Questionnaire Prime.docx | DOCX document | |
| RFI Form.pdf | ||
| Conflict of Interest.docx | DOCX document | |
| 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 | |
| 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 |
Show all 17
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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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| CONFLICT OF INTEREST DISCLOSURE FORM |
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