Form_1_Vendor_Declaration_Statement.pdf
PDF 122 KB Posted
- Solicitation number
- 25-8523
- Issued by
- Collier County, Florida
About this file
This is a Vendor Declaration Statement form issued by Collier County Government in Florida for the Bypass Pump Preventative Maintenance, Repair and Replacement solicitation. The form serves as a certification requirement for vendors submitting bids or proposals to the Collier County Board of County Commissioners Procurement Services Division. Vendors must declare that their response is made without collusion, fraud, or arrangement with other parties and in compliance with the County's Procurement Ordinance and ethical standards. The vendor must certify that no elected or appointed officials, their spouses, or household members have a financial interest exceeding one percent in the proposed goods or services, and vendors must disclose any relatives of County officials with financial interests in the bid. Additionally, vendors confirm they have fully examined and accepted all instructions, terms, conditions, requirements, and specifications outlined in the solicitation.
By executing this declaration, the vendor agrees to accept a Purchase Order or formal Collier County contract if awarded and to comply with all stated terms, conditions, and specifications. Vendors acknowledge that their submission is based on documents listed in the solicitation and agree to the submitted pricing. The form includes a specific provision prohibiting mark-ups on subcontractor fees when a subcontractor is a related entity, defined as any parent, subsidiary, or entity in which the company holds ownership interest. The undersigned corporate authorized representative with signature authority must certify under penalties of perjury that all information provided is correct and complete.
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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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