No Conflict of Interest (37).pdf
PDF 77 KB Posted
- Solicitation number
- PE-64800-NONST-2026-000000070
- 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 state and local contract opportunities in Georgia. The certification requires bidders to attest that no members of the Douglas County Board of Commissioners, elected or appointed officials and employees of Douglas County, State of Georgia officials or employees, relatives of aforementioned persons, or members or delegates of the United States Congress have any direct or indirect interest in the bidder's organization or in the proceeds of any contract that may result from the bid, quote, or qualification statement. The certifying party must be legally authorized by the bidder to make this representation and must affirm that the representation is true to the best of their knowledge and belief without deliberate omission of any relevant facts.
The form requires the bidder to disclose any exceptions to the conflict of interest certification with detailed explanations. The completed certification must be signed and submitted with the bid submission. The certifying official must provide their signature, printed name, title, telephone number, email address, company name, and company address. Any misrepresentation made in this certification knowing it to be false may result in the bidder's disqualification from being awarded the contract and from future work with the Douglas County Board of Commissioners.
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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 .