FORM 02-NOTICE OF CONFLICT OF INTEREST.pdf
PDF 133 KB Posted
- Attached to
- MyFloridaNet-3 ITN
- Solicitation number
- ITN-16760
- Issued by
- Florida
About this file
This is a Notice of Conflict of Interest form issued by the State of Florida Department of Management Services for ITN No. DMS-26/27-025 (MyFloridaNetwork-3). The form is designed to ensure compliance with Chapter 112, Florida Statutes, and requires respondents to disclose any conflicts of interest prior to participating in the solicitation process. Respondents must identify corporate officers, directors, or agents who are currently employed by the State of Florida or any of its agencies, as well as any current State of Florida employees who own an interest of five percent (5%) or more in the responding company. The form requires the company name, signature of an authorized representative with date, and printed name of the signatory.
The form serves as a mandatory disclosure document that bidders must complete and submit as part of their proposal package. Any conflicts of interest must be explicitly noted in the designated sections, or respondents must indicate "N/A" if no conflicts exist. This document is a compliance requirement rather than a pricing or contract terms document and does not contain information regarding pricing, set-asides, funding, or contract duration.
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Text version
ITN No.: DMS-26/27-025 Page 1 of 2 MyFloridaNet-3
FORM 02 – NOTICE OF CONFLICT OF INTEREST
4050 Esplanade Way Tallahassee, FL 32399-0950
850-488-2786
Ron DeSantis, Governor Tom Berger, Secretary
FOR
MyFloridaNetwork-3
ITN NO: 26/27-025
THE STATE OF FLORIDA
DEPARTMENT OF MANAGEMENT SERVICES
ITN No.: DMS-26/27-025 Page 2 of 2 MyFloridaNet-3
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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