Conflict of Interest.pdf
PDF 179 KB Posted
- Solicitation number
- RFP 360 2026052 2
- Issued by
- Palm Beach County, Florida
About this file
This is a Conflict of Interest Disclosure Form for Palm Beach County, Florida, related to a Street Lighting Professional Continuing Services Contract. The form requires consultants and annual consultants to certify that they have no direct or indirect interests that would conflict with the performance of services for the County, except as specifically disclosed. Consultants must represent that they will not acquire any conflicting interests during the contract term and that no employees with conflicting interests will be assigned to the work. The form references compliance with Chapter 112, Part III of Florida Statutes and Section 2-441 et seq. of the Palm Beach County Code of Ethics.
Consultants are required to promptly notify Palm Beach County in writing by certified mail of any potential conflicts of interest that may arise in the future, including prospective business associations or circumstances that could influence judgment or service quality. Upon notification, the County will provide an opinion regarding whether the prospective interest constitutes an unacceptable conflict. If the County determines a conflict exists, the consultant must not enter into that association or circumstance. The form must be signed by an authorized representative and certifies that all disclosed information is true and correct. The document notes that any misrepresentation constitutes an unethical business practice and grounds for sanctions against future County business relationships.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 2026052 RFP Package.pdf | ||
| OSBD Schedules and Instructions.pdf | ||
| Prime Firms SBE Past Participation Statement.pdf | ||
| RFI Form.pdf | ||
| Qualification Questionnaire Prime.pdf | ||
| 2026052 Pre Proposal Sign In Sheet.pdf | ||
| RFI Form.docx | DOCX document | |
| Qualification Questionnaire Subconsultant.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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)
| Untitled |
| Untitled |
| CONFLICT OF INTEREST DISCLOSURE FORM |
File details come from the government source that posted it. Updated .