Form_1_Vendor_Declaration_Statement.pdf
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- Attached to
- CONSTRUCTION ENGINEERING AND INSPECTION SERVICES FOR PINE RIDGE ROAD CORRIDOR IMPROVEMENTS
- Solicitation number
- 26-8674
- Issued by
- Collier County, Florida
About this file
This is a Vendor Declaration Statement form issued by the Board of County Commissioners for Collier County, Florida, applicable to the Construction Engineering and Inspection (CEI) Services solicitation for the Pine Ridge Road Corridor Improvements Project. The form serves as a formal declaration that vendors submitting bids or proposals for this project have examined and accepted all instructions, purchase order terms and conditions, requirements, and specifications outlined in the solicitation. Vendors must certify that their response is made without collusion or fraud and in compliance with the Collier County Procurement Ordinance, Section Seven, Ethical Standards. The project involves CEI services for approximately one mile of road and intersection improvements along Pine Ridge Road, from west of the intersection with Livingston Road to east of Whippoorwill Lane, plus improvements extending approximately one-half mile along Livingston Road. Project improvements include a new "Jug-Handle" intersection design at the Pine Ridge Road/Livingston Road intersection to facilitate left-turning traffic, a conventional intersection at Pine Ridge Road/Whippoorwill Lane, drainage improvements, sidewalk installation, and traffic signal installation.
The declaration requires vendors to disclose any financial interests held by elected or appointed county officials, their spouses, or household members in the business submitting the bid, with financial interest defined as ownership exceeding one percent of total assets or capital stock or holding an officer, director, manager, partner, proprietor, or agent position. Vendors must also disclose any relatives of county officials or employees with financial interests in the proposed work and agree to the county's sole discretion in determining whether conflicts exist. The form further stipulates that if a subcontractor is a related entity to the vendor, the vendor shall not mark up the subcontractor's fees, with related entities defined as parent or subsidiary companies or any business entity in which the vendor holds any ownership interest. All vendors submitting responses must execute this declaration under penalty of perjury, signed by a duly authorized corporate representative with signature authority.
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Text version
Version 2 9.2.25
Procurement Services Division
Form 1: Vendor Declaration Statement
BOARD OF COUNTY COMMISSIONERS
Collier County Government Complex Naples, Florida 34112
Dear Commissioners:
The undersigned, as Vendor declares that this response is made without connection or arrangement with any other person and the bid/proposal submittal is in every respect fair and made in good faith, without collusion or fraud and in compliance with the Procurement Ordinance, Section Seven, Ethical Standards.
The vendor certifies to the best of their knowledge or belief, no elected/appointed official or employee of Collier County, a spouse thereof or other person residing in the same household, is financially interested, directly or indirectly, in providing the goods or services specified in any submitted bid or proposal. A financial interest is defined as ownership of more than one percent (1%) of the total assets or capital stock or being an officer, director, manager, partner, proprietor, or agent of the business submitting the bid or proposal or of any subcontractor or supplier thereof providing goods or services in excess of one percent (1%) of the total bid or proposal amount. Additionally, the vendor, on company letterhead, must divulge at the time of the submittal of a bid or proposal, any relative, other than those already specified, of an elected or appointed official or employee of the County who has a financial interest, in providing the goods or services specified in the bid or proposal. The County, at its sole discretion, will determine whether a conflict exists and whether to accept or reject the bid or proposal.
The Vendor hereby declares the instructions, purchase order terms and conditions, requirements, and specifications/scope of work of this solicitation have been fully examined and accepted.
The Vendor agrees, if this solicitation submittal is accepted by Collier County, to accept a Purchase Order as a form of a formal contract or to execute a Collier County formal contract for purposes of establishing a contractual relationship between the Vendor and Collier County, for the performance of all requirements to which this solicitation pertains. The Vendor states that the submitted is based upon the documents listed in this solicitation. The Vendor agrees to comply with the requirements in accordance with the terms, conditions and specifications denoted herein and according to the pricing submitted as a part of the Vendor’s bids.
Further, the Vendor agrees that if awarded a contract for these goods and/or services and a subcontractor is a related entity to the Vendor, then the Vendor shall not mark-up the subcontractor’s fees. A related entity shall be defined as any parent or subsidiary of the company and any business, corporation, partnership, limited liability company or other entity in which the company or a parent or a subsidiary of the company holds any ownership interest, directly or indirectly.
Under penalties of perjury, I certify that the information shown on this form is correct to my knowledge and a duly corporate authorized representative with signature authority.
Company Name: _________________________________________
Date: _____________________________
Signature: ____________________________________________ Title: _____________________________
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