Form_1_Vendor_Declaration_Statement.pdf
PDF 122 KB Posted
- Attached to
- Wellness Engagement Platform
- Solicitation number
- 26-8653
- 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, in conjunction with a Request for Proposals for a Wellness Engagement Platform. The form serves as a certification document that vendors must complete and submit with their proposal responses. Vendors are required to declare that their submission is made without collusion, fraud, or improper arrangements with other parties, and that it complies with the County's Procurement Ordinance and ethical standards. The form also requires vendors to confirm they have fully examined and accepted all instructions, terms, conditions, requirements, and specifications outlined in the solicitation. If awarded, vendors agree to accept either a Purchase Order or execute a formal Collier County contract to establish the contractual relationship for performance of all required goods and services.
The declaration must be executed under penalty of perjury by a duly authorized corporate representative with signature authority, and vendors must disclose any financial interests held by elected or appointed County officials, their spouses, or household members exceeding one percent of total assets or capital stock. Additionally, vendors must reveal any relatives of County officials with financial interests in the proposed goods or services, with the County retaining sole discretion to determine whether conflicts exist and whether to accept or reject the proposal. Vendors with related entity subcontractors are prohibited from marking up subcontractor fees, with related entities defined as parent or subsidiary companies or any business in which the vendor holds ownership interest.
View the file
Other files
Show all 13
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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: _____________________________
| Company Name: |
| Date19_af_date: |
| Title: |
File details come from the government source that posted it. Updated .