Conflict of Interest.pdf
PDF 179 KB Posted
- Solicitation number
- RFP 360 2026052 1
- Issued by
- Palm Beach County, Florida
About this file
This is a Conflict of Interest Disclosure Form required for consultants and annual consultants engaged by Palm Beach County, Florida in connection with a Street Lighting Professional Continuing Services Contract. The form mandates that all parties performing services must certify they have no direct or indirect interests that would conflict with their performance of work for the County, or must fully disclose any existing conflicts in the designated space provided. The disclosure applies to all persons who will be employed for the performance of services, establishing a comprehensive conflict of interest certification requirement at the outset of the consulting engagement.
The form requires consultants to represent compliance with Chapter 112, Part III of the Florida Statutes and Section 2-441 et seq. of the Palm Beach County Code of Ethics, and obligates them to promptly notify the County in writing via certified mail of any potential conflicts that may arise during the contract period. Consultants must request a written opinion from the County regarding whether prospective business associations or interests would constitute unacceptable conflicts, and are prohibited from pursuing any association or interest that the County deems an unacceptable conflict. The form must be signed by an authorized representative of the consulting firm, with false or misleading statements considered unethical business practices subject to sanctions and potential exclusion from future County contracts.
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Other files
| File | Type | Posted |
|---|---|---|
| 2026052 RFP Package.pdf | ||
| Qualification Questionnaire Subconsultant.pdf | ||
| OSBD Schedules and Instructions.pdf | ||
| Prime Firms SBE Past Participation Statement.pdf | ||
| RFI Form.pdf | ||
| RFI Form.docx | DOCX document | |
| Qualification Questionnaire Prime.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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| CONFLICT OF INTEREST DISCLOSURE FORM |
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