FORM 2 - Notice of Conflict of Interest.pdf

PDF 98 KB Posted

Attached to
Operation and Management of Contractor-Operated Correctional Facilities – South Bay CF
Solicitation number
ITN-17169
Issued by
Palm Beach County, Florida

About this file

This is a Notice of Conflict of Interest Form (Form 2) required for participation in ITN FDC-ITN-27-023, issued by the Florida Department of Corrections for the operation and management of contractor-operated correctional facilities, specifically the South Bay Correctional Facility. The form serves as a compliance document under Chapter 112, Florida Statutes, requiring respondents to disclose any conflicts of interest prior to participating in the solicitation process. Respondents must identify corporate officers, directors, or agents who are currently employed by the State of Florida or its agencies, as well as any current State of Florida employees who own five percent or more interest in the responding company. The form requires completion by an authorized representative with signature and date.

Responses to the solicitation must be submitted through the MyFloridaMarketPlace Sourcing Event via the SAP Business Network. Interested vendors should direct inquiries to Sharita Newman, Procurement Officer, at the Florida Department of Corrections, with all emails containing the solicitation number FDC-ITN-27-023 in the subject line. The form itself contains no pricing terms, set-asides, or contract duration information, serving solely as a conflict of interest disclosure document required as part of the response submission process.

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Other files

File Type Posted
FORM 3 - Statement of No involvement.pdf PDF
Attachment H - Current Facility Program Plan - South Bay.pdf PDF
FORM 1 - Contact Information.pdf PDF
FORM 7 - Pass Fail Requirement Certification and Non-Collusion Certification.pdf PDF
FORM 5 - Subcontracting.pdf PDF
Attachment B - South Bay Fixtures, Furnishings & Equipment Inventory.pdf PDF
FORM 8 - PUR1355 Foreign Country of Concern Attestation.docx DOCX document
Attachment L - Reference Questionnaire.docx DOCX document
FORM 9 - PUR 7801 Vendor Certification Form.docx DOCX document
FORM 10 - PUR 2023 and PUR 2024 Combined.pdf PDF
Attachment G - Florida Department of Corrections Alphabetical State Drug Formulary August 2026.pdf PDF
Attachment E - South Bay Operating Per Diem.pdf PDF
Attachment J - Confidentiality and Non-Disclosure Agreement.pdf PDF
ITN-27-023 Contractor Operated CF SBay Final.pdf PDF
FORM 12 - REPLY BOND FORM.docx DOCX document
Exhibit K - Quarterly Performance Measures and Deliverables - South Bay.pdf PDF
Exhibit M - 27-28 IWTF Request Template.pdf PDF
FORM 6 - Mandatory Responsiveness Requiements.pdf PDF
Attachment F - Florida Department of Corrections Menu 2025-2026.pdf PDF
FORM 4 - Business Experience.pdf PDF
Attachment C - South Bay Price Sheet.xlsx XLSX spreadsheet
Exhibit J - Transition Schedule Requirements - South Bay.pdf PDF
FORM 11 - DRUG FREE WORKPLACE.pdf PDF
Attachment M - Business Associate Agreement for HIPPA.docx DOCX document
Exhibit I - Transition Plan Requirements - South Bay.pdf PDF
Show all 25

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Text version

FORM 2 - NOTICE OF CONFLICT OF INTEREST

FDC-ITN-27-023

Operation and Management of Contractor-Operated Correctional Facilities

For the purpose of participating in the solicitation process and complying with the provisions of Chapter 112, Florida Statutes, the company states the following conflict(s) of interest exists as noted below (if none, write N/A in the applicable section(s) below):

The persons listed below are corporate officers, directors, or agents and are currently employees of the State of Florida or one of its agencies:

The persons listed below are current State of Florida employees who own an interest of five percent (5%) or more in the company named above:

Respondent’s Name Signature of Authorized Representative

Date Print Name/Title

REMAINDER OF PAGE INTENTIONALLY LEFT BLANK

File details come from the government source that posted it. Updated .