No Conflict of Interest (29).pdf
PDF 77 KB Posted
- Attached to
- Public Transit3rd Party Transportation Operator
- Solicitation number
- PE-64800-NONST-2026-000000062
- Issued by
- Douglas County, Georgia
About this file
This is a No Conflict of Interest certification form required by the Douglas County Board of Commissioners for the Public Transit Third Party Transportation Operator contract opportunity in Georgia. The certification form must be signed and submitted with all bids and requires the bidder's authorized representative to attest that no members of the Douglas County Board of Commissioners, state of Georgia officials or employees, relatives of such persons, or members or delegates to the U.S. Congress have any direct or indirect interest in the bidder's organization or in the proceeds of any potential contract resulting from the bid submission. The form includes fields for the signatory's signature, printed name, title, telephone number, email address, company name, and address, with a space provided for bidders to disclose any exceptions to the certification with detailed explanations.
The certification carries significant consequences for non-compliance, as any representation made with knowledge of its falsity may result in disqualification of the bidder from contract award and future work with Douglas County Board of Commissioners. Bidders are required to certify their representations as true to the best of their knowledge and belief and warrant that they have conducted sufficient inquiry to ensure the accuracy of their declarations. This certification requirement applies to the solicitation for various public transit services in support of Douglas County's Connect Douglas program, which includes fixed route service, ADA paratransit service, and potential future on-demand or microtransit operations, with all services required to comply with Federal Transit Administration, Georgia Department of Transportation, and Douglas County requirements.
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Text version
NO CONFLICT OF INTEREST
Except as may be identified and explained below, the undersigned hereby certifies that: (a) no member of the Board of Commissioners, elected, appointed, and employee of the Douglas County;
(b) no elected, appointed, and employed official or employee of the State of Georgia and of a governing body, instrumentality, or political subdivision; (c) no relative of any persons described above; (d) no member of and delegate to the Congress of the United States has an interest whatsoever (regardless of how indirect and how remote that interest may be) in bidder’s organization and in the proceeds of a Contract and agreement which might be made between bidder and the Douglas County Board of Commissioners as a result of the, quote, or qualification statement accompanied by this certification.
The undersigned certifies that he/she is legally authorized by the bidder to make the above representation, and that the representation is true to the best of his/her knowledge and belief and without deliberate omission of any inquiry which would to the best of his/her belief tend to change the above representation. The undersigned understands that any representation made knowing it to be false may disqualify the bidder from being awarded the Contract and future work by Douglas County Board of Commissioners.
NOTE: THIS CERTIFICATION MUST BE SIGNED AND SUBMITTED WITH THIS BID.
EXCEPTIONS: (Please explain)
Signature:
Print Name:
Title: Telephone #:
Email:
Name of Company:
Address:
File details come from the government source that posted it. Updated .