No Conflict of Interest (30).pdf
PDF 77 KB Posted
- Attached to
- NFPA 1582 Firefighter Annual Medical Physicals
- Solicitation number
- PE-64800-NONST-2026-000000063
- Issued by
- Georgia
About this file
This is a No Conflict of Interest certification form required for bid submission to Douglas County, Georgia in response to the NFPA 1582 Firefighter Annual Medical Physicals Request for Proposal. The certification requires the bidder to attest that no members of the Douglas County Board of Commissioners, State of Georgia officials or employees, relatives of such persons, or members of Congress have any direct or indirect interest in the bidding organization or the potential contract proceeds. The form mandates that the certifying official be legally authorized by the bidder to make these representations and warrants that all statements are true to the best of their knowledge without omission of any relevant information.
The certification must be signed and submitted with the bid submission and serves as a compliance requirement for bid consideration. Bidders must identify and explain any exceptions to the conflict of interest statement in a designated section. Misrepresentation of conflict of interest information may result in disqualification from contract award and future work with Douglas County Board of Commissioners. The form requires standard identifying information including the signatory's signature, printed name, title, telephone number, email address, company name, and business address.
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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 .