Form_1_Vendor_Declaration_Statement.pdf
PDF 122 KB Posted
- Solicitation number
- 26-8688
- Issued by
- Collier County, Florida
About this file
This is a Vendor Declaration Statement form issued by the Collier County Board of County Commissioners Procurement Services Division in Naples, Florida, for use in conjunction with a Request for Professional Services solicitation for Design Services – Lake Park Improvements & Flow Way Restoration. The form requires vendors to declare that their bid or proposal is submitted fairly and in good faith, without collusion or fraud, and in compliance with the County's Procurement Ordinance Section Seven regarding ethical standards. Vendors must certify that no elected or appointed officials, their spouses, or household members have a financial interest (defined as ownership exceeding one percent of total assets or capital stock, or positions as officers, directors, managers, partners, proprietors, or agents) in the goods or services being provided. Vendors are required to disclose any relatives of County officials or employees who have financial interests in the proposed goods or services, with the County retaining sole discretion to determine conflicts of interest and accept or reject submissions accordingly.
The vendor must affirm that all solicitation instructions, purchase order terms and conditions, requirements, and specifications have been fully examined and accepted, and agrees to accept either a Purchase Order or formal Collier County contract as the basis for the contractual relationship. If awarded and a subcontractor is a related entity—defined as any parent, subsidiary, or business entity in which the vendor holds any ownership interest—the vendor agrees not to mark up the subcontractor's fees. The declaration must be submitted under penalties of perjury by a duly authorized corporate representative with signature authority, and includes signature and date lines for completion on company letterhead.
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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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