FORM 02-NOTICE OF CONFLICT OF INTEREST.pdf
PDF 132 KB Posted
- Attached to
- MyFloridaNet-3 Core Services - ITN
- Solicitation number
- ITN-12980
- Issued by
- Clay County, Leon County, Polk County, Florida
About this file
This document is a Conflict of Interest Form (Form 02) issued by the State of Florida's Department of Management Services for the MyFloridaNetwork-3 solicitation, with the Invitation to Negotiate (ITN) number 24/25-260. The form is designed to ensure transparency and compliance with Chapter 112 of Florida Statutes during the solicitation process for MyFloridaNet-3 Core Services. The document provides a template for potential respondents to disclose any conflicts of interest, specifically requiring companies to report if they have corporate officers, directors, or agents who are current state employees, or if any current state employees own a 5% or greater interest in the company.
The form serves as a critical compliance mechanism for the MyFloridaNetwork-3 procurement, requiring full disclosure of potential conflicts that might compromise the integrity of the bidding process. By mandating that companies reveal any connections between their personnel and state government employees, the form helps maintain ethical standards and prevents potential unfair advantages or improper influences in the state's procurement activities. Respondents are expected to either list any conflicts of interest or write "N/A" if no conflicts exist, with the form to be signed by an authorized representative of the responding organization.
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Text version
ITN No.: DMS-24/25-260 Page 1 of 2 MyFloridaNet-3 Core Services
FORM 02 – NOTICE OF CONFLICT OF INTEREST
4050 Esplanade Way Tallahassee, FL 32399-0950
850-488-2786
Ron DeSantis, Governor Pedro Allende, Secretary
FOR
MyFloridaNetwork-3
ITN NO: 24/25-260
THE STATE OF FLORIDA
DEPARTMENT OF MANAGEMENT SERVICES
ITN No.: DMS-24/25-260 Page 2 of 2 MyFloridaNet-3 Core Services
FORM 02 - NOTICE OF CONFLICT OF INTEREST
Company Name
For the purpose of participating in the solicitation process and complying with the provisions of Chapter 112, Florida Statutes, the company states the following conflict(s) of interest exists as noted below (if none, write N/A in the applicable section(s) below):
The persons listed below are corporate officers, directors, or agents and are currently employees of the State of Florida or one of its agencies:
The persons listed below are current State of Florida employees who own an interest of f ive percent (5%) or more in the company named above:
Name of Respondent’s Organization Signature of Authorized Representative and Date
Print Name
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