ITB202608_CDBG_Infrastructure_Improvement_Project__Exhibit_I.pdf

EXHIBIT I – CONFLICT-OF-INTEREST CERTIFICATION

CDGB Infrastructure Improvement Project

Authority: Chapter 112, F.S.; §§ 112.313, 112.3148, 112.312, F.S.

Contract No. CDBG-CON-01

Vendor Information

Vendor Name: ________________________________________

Business Address: _________________________________________

Primary Contact Name & Title: ______________________________

Phone: ____________________ Email: ________________________

Solicitation / Bid No.: ____________________________________

Acknowledgement

The undersigned Vendor acknowledges that it has received, read, and understands the City of

Milton Conflict of Interest Policy No. 1.3, and that it is responsible for complying with applicable conflict-of-interest requirements and for disclosing any actual or potential conflict of interest, or any circumstance that could reasonably be perceived as creating a conflict under applicable law.

Conflict Disclosure

For purposes of this disclosure, “Vendor” means the business entity submitting a bid, proposal, or quotation to the City of Milton, or entering into a contract with the City, and includes the

Vendor’s owners, officers, principals, directors, managers, key employees, agents, consultants, subcontractors, and any other persons or entities acting on the Vendor’s behalf in connection with the solicitation or performance of the contract, to the extent known at the time of submission.

Does the Vendor have any actual, potential, or perceived conflict of interest related to this solicitation or any resulting contract with the City, including, but not limited to, any of the following:

• A business, financial, or employment relationship between the Vendor and any City of

Milton employee, elected official, or appointed official;

• A business, financial, or contractual relationship between the Vendor and a relative (as defined in §112.312(21), F.S.) of any City employee or official involved in this solicitation or contract;

• Any conduct by the Vendor, or anyone acting on its behalf, intended to improperly influence the solicitation, evaluation, selection, negotiation, award, or administration of a

City contract;

• Any gift, benefit, favor, or gratuity prohibited under Chapter 112, F.S.; or

• Any other circumstance that could reasonably be perceived as impairing the integrity of the City’s procurement or contract administration process.

EXHIBIT I – CONFLICT-OF-INTEREST CERTIFICATION

CDGB Infrastructure Improvement Project

Authority: Chapter 112, F.S.; §§ 112.313, 112.3148, 112.312, F.S.

Contract No. CDBG-CON-01

☐ Yes ☐ No

If yes, describe the nature of the conflict and the City matter involved:

Ongoing Duty to Disclose

The Vendor acknowledges that it has a continuing obligation to promptly disclose, in writing, any conflict of interest that arises after submission of this disclosure and during the term of any resulting contract.

☐ Acknowledged

Certification

I certify under penalty of perjury under the laws of the State of Florida that the information provided in this disclosure is true, complete, and accurate to the best of my knowledge and belief. I understand that failure to disclose a conflict of interest, or providing false or misleading information, may result in disqualification, rejection of a bid or proposal, termination of contract, or other remedies available to the City under law or contract.

Bidder/Contractor: ___________________________________________

Authorized Signature: ______________________________________________

Printed Name: _____________________________________________________

Title: _____________________________________________

Date: ____________________________________________