Independence_Affidavit.pdf
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- Attached to
- SOUTHWEST 34TH TERRACE DRAINAGE PROJECT
- Solicitation number
- 24-032
- Issued by
- Charles County, Florida
About this file
The Independence Affidavit is a legal document related to a state and local contract opportunity for the Southwest 34th Terrace Drainage Project in Florida, specifically involving Charles County Commissioners. The document is a sworn statement requiring the bidder to disclose any potential conflicts of interest, relationships with city officials, or prior contracts with the city within the past five years. The affidavit mandates transparency about professional, financial, familial, or other relationships with the city, its officials, employees, agents, or selection committee members, with a broad definition of "relationship" that includes various professional and personal connections.
The affidavit requires the bidder to certify that neither they nor household members have received any promises of compensation, gifts, or gratuities in exchange for the bid. The document must be signed in blue ink and notarized in the State of Florida, with the signatory agreeing to provide written notice of any future relationships with the city during the agreement period. The notarization section allows for either physical presence or online notarization, emphasizing the document's legal requirement for bidders participating in the state and local contract opportunity to demonstrate independence and ethical conduct in the procurement process.
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Text version
INDEPENDENCE AFFIDAVIT
The undersigned individual, being duly sworn, deposes and says that:
I am _______________________________ of _____________________________, the Bidder that has submitted the attached Bid;
I hereby certify to the best of my knowledge that neither I nor any of those persons residing in my household have or have had during the past five years, any relationships (professional, financial, familial or otherwise) with the City (or any of its districts), its elected or appointed officials, its employees or agents, or any member or alternate member of the Selection Committee.
A “relationship” for the purpose of this affidavit shall include but not be limited to employer/employee, consultant, contractor, subcontractor, associate, officer, partnership, joint venture, ownership greater than one percent, landlord/tenant, or creditor/debtor, gift donor/recipient (in excess of $100.00), past or on-going personal relationships, or joint involvement with charitable/voluntary activities. Relationship includes having a prior or current contract with the City.
Except as set forth below, I hereby certify to the best of my knowledge that neither I nor any of those persons residing in my household have received any promise of compensation, remuneration, gift, discount, or other gratuity in exchange for my Bid.
I understand and agree that I shall give the City written notice of any other relationships (as defined above) that I enter into with the City (or any of its districts), its elected or appointed officials, its employees or agents, or any member or alternate member of the Selection Committee during the period of the Agreement.
I set forth below any exceptions to the aforementioned (if none, write “None”):
Signature (Blue ink only)
Print Name
Title
Date
STATE OF FLORIDA
COUNTY OF
BEFORE ME, an officer duly authorized by law to administer oaths and take acknowledgments, personally appeared ☐ physical presence or ☐ online notarization, on _________________ as _________________, of ___________________, an organization authorized to do business in the State of Florida, and acknowledged and executed the foregoing statement as the proper official of _______________________ for the use and purposes mentioned in it and affixed the official seal of the entity, and that the instrument is the act and deed of that entity. He/she is personally known to me or has produced __________________________ as identification.
Notary Public
INDEPENDENCE AFFIDAVIT
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