FORM 04-STATEMENT OF NO PRIOR DISQUALIFYING INVOLVEMENT.pdf
PDF 136 KB Posted
- Attached to
- MyFloridaNet-3 ITN
- Solicitation number
- ITN-16760
- Issued by
- Florida
About this file
This is a Statement of No Prior Disqualifying Involvement form for the MyFloridaNetwork-3 Invitation to Negotiate (ITN No. DMS-26/27-025) issued by the State of Florida Department of Management Services. The form serves as a certification requirement for respondents participating in this solicitation.
The form requires an authorized representative of the responding organization to certify compliance with Florida Statutes Section 287.057(19)(c), which prohibits certain entities from contracting with the state. Specifically, any person or firm that received a prior contract to perform a feasibility study, participated in drafting the solicitation, or developed a program for future implementation is ineligible to contract for other contracts dealing with that specific subject matter. The statute contains an exception allowing respondents who previously submitted responses to requests for information to remain eligible to contract. This certification must be signed and dated by an authorized representative and include the name of the respondent's organization and the printed name of the signatory.
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ITN No.: DMS-26/27-025 Page 1 of 2 MyFloridaNet-3
FORM 04 – STATEMENT OF NO PRIOR DISQUALIFYING INVOLVEMENT
4050 Esplanade Way Tallahassee, FL 32399-0950
850-488-2786
Ron DeSantis, Governor Tom Berger, Secretary
FORM 04 – STATEMENT OF NO PRIOR DISQUALIFYING INVOLVEMENT
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 04 – STATEMENT OF NO PRIOR DISQUALIFYING IINVOLVEMENT
FORM 04 - STATEMENT OF NO PRIOR DISQUALIFYING INVOLVEMENT
I, as an authorized representative of the Respondent, certify that nothing in section 287.057(19)(c), F.S., (below), prohibits the Respondent’s entry into any Contract resulting from this solicitation.
287.057 Procurement of commodities or contractual services. — (19)(c) A person who receives a contract that has not been procured pursuant to subsections (1)-(3) [of s.
287.057, F.S.] to perform a feasibility study of the potential implementation of a subsequent contract, who participates in the drafting of a solicitation or who develops a program for future implementation, is not eligible to contract with the agency for any other contracts dealing with that specific subject matter, and any firm in which such person has any interest is not eligible to receive such contract. However, this prohibition does not prevent a Respondent who responds to a request for information from being eligible to contract with an agency.
Name of Respondent’s Organization Signature of Authorized Representative and Date
Print Name
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