Conflict of Interest Statement Form.pdf
PDF 1 MB Posted
- Attached to
- 26B-120 2 Cubic Yard (Cy) Stationary Garbage Compactor Units – Cram-A-Lot Model St-2hf Or Approved Alternate
- Solicitation number
- 26-120
- Issued by
- Marion County, Florida
About this file
This is a Conflict of Interest Statement Form required by Florida Statute 112.313 for vendors bidding on Marion County Solid Waste's procurement for two cubic yard stationary garbage compactor units (Cram-A-Lot Model ST-2HF or approved equal). The form is designed to identify any conflicts of interest between bidders and Marion County employees, public officers, or advisory board members. Bidders must disclose whether they are County employees or advisory board members, related to such individuals, have material ownership interests in the respondent company exceeding five percent, employ County officials, or are former MCBCC employees with less than one year of inactive service. The solicitation requires bids by August 20, 2026, with the County intending to select a vendor within sixty calendar days of the bid deadline. The compactor units must include remote hydraulic power units, controls, installation, startup, testing, and documentation, with optional pricing for an open-top hopper and photocell automatic cycle control system. All bids must comply with specified structural, hydraulic, electrical, UL, OSHA, and ANSI requirements.
Bidders must provide at least three references documenting similar prior work and submit the Conflict of Interest Statement Form along with a Vendor Information Form and Disclosure of Subcontractors and Suppliers. The County reserves the right to accept or reject any proposed subcontractor and will award to the lowest responsive and responsible bidder. Bids must remain firm and valid for a minimum of ninety calendar days after submission. Payment terms default to NET 45 days from invoice receipt or final acceptance, with a Visa p-card option providing payment within seventy-two hours. Contractors must maintain comprehensive insurance coverage including workers' compensation, commercial general liability, and business automobile liability with Marion County named as additional insured. All bids must be submitted electronically through https://marionfl.bonfirehub.com, with new vendors required to register through PaymentWorks and existing vendors required to update company information changes.
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Text version
CONFLICT OF INTEREST STATEMENT
Florida Statute §112.313 places limitations on public officers (including advisory board members) and employees' ability to contract with the County either directly or indirectly. Therefore, please indicate if the following applies:
PART 1.
I am an employee, public officer, or an advisory board member of the County (LIST).
NAME:
I am the spouse or child of an employee, public officer or advisory board member of the County.
NAME:
An employee, public officer, or advisory board member of the County, or their spouse or child, is an officer, partner, director, or proprietor of Respondent or has a material interest in Respondent. "Material interest" means direct or indirect ownership of more than five percent (5%) of the total assets or capital stock of any business entity. For the purposes of FS §112.313, indirect ownership does not include ownership by a spouse or minor child.
NAME:
Respondent employs or contracts with an employee, public officer, or advisory board member of the County.
NAME:
Principal or Agent is former employee of MCBCC with less than one (1) year of inactive service.
NAME:
NONE OF THE ABOVE
PART 2.
Are you going to request an advisory board member waiver?
I will request an advisory board member waiver under FS §112.313(12)
I will NOT request an advisory board member waiver under FS §112.313(12)
N/A
The County shall review any relationship which may be prohibited under the Florida Ethics Code and will disqualify any vendor whose conflicts are not waived or exempt.
COMPANY:
PRINTED NAME:
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