Form_2_Conflict_of_Interest_Certification.pdf

Version 2 9.2.25

Procurement Services Division

Form 2: Conflict of Interest Certification

The Vendor certifies that, to the best of its knowledge and belief, the past and current work on any Collier County project affiliated with this solicitation does not pose a conflict of interest and is in compliance with the Procurement Ordinance, Section Seven, Ethical Standards, that states:

“A consultant who participates in the drafting of a solicitation or scope or who develops a program for future implementation that gives rise to an actual conflict so as to unfairly benefit that consultant to the disadvantage of any other future firms that could competitively seek a County contract related to such program or project upon which the solicitation or scope is based, and which conflict is not otherwise curable, is not eligible to contract with the County 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 vendor who responds to a request for information from being eligible to contract with the County.”

The Vendor certifies that, to the best of its knowledge and belief, the past and current work on any Collier County project affiliated with this solicitation does not pose a conflict of interest as described by one of the three categories below:

Biased ground rules – The firm has not set the “ground rules” for affiliated past or current Collier County project identified above (e.g., writing a procurement’s statement of work, specifications, or performing systems engineering and technical direction for the procurement) which appears to skew the competition in favor of my firm.

Impaired objectivity – The firm has not performed work on an affiliated past or current Collier County project identified above to evaluate proposals / past performance of itself or a competitor, which calls into question the contractor’s ability to render impartial advice to the government.

Unequal access to information – The firm has not had access to nonpublic information as part of its performance of a Collier County project identified above which may have provided the contractor (or an affiliate) with an unfair competitive advantage in current or future solicitations and contracts.

In addition, the contractor / vendor must provide the following, if applicable:

1. All documents produced as a result of the work completed in the past or currently being worked on for the above-mentioned project; and,

2. Indicate if the information produced was obtained as a matter of public record (in the “sunshine”) or through non-public (not in the “sunshine”) conversation (s), meeting(s), document(s) and/or other means.

Failure to disclose all material or having a conflict of interest identified in one or more of the above three categories may result in the disqualification for future solicitations affiliated with the above referenced project(s).

By the signature below, the firm (employees, officers and/or agents) certifies, and hereby discloses, that, to the best of their knowledge and belief, all relevant facts concerning past, present, or currently planned interest or activity (financial, contractual, organizational, or otherwise) which relates to the project identified above has been fully disclosed and does not pose an organizational conflict.

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: _____________________________