No Conflict of Interest (46).pdf
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- Solicitation number
- PE-64800-NONST-2026-000000077
- 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 bid submission. The form certifies that no members of the Douglas County Board of Commissioners, elected or appointed officials and employees of Douglas County, State of Georgia officials and employees, relatives of aforementioned persons, or U.S. Congressional members or delegates have any interest, direct or indirect, in the bidder's organization or in the proceeds of any contract resulting from the bid, quote, or qualification statement. The undersigned certifies legal authorization to make this representation and affirms its truthfulness to the best of their knowledge without omission of relevant information.
The certification must be signed and submitted with the bid submission. Any bidder who knowingly submits a false representation may be disqualified from contract award and future work opportunities with Douglas County Board of Commissioners. The form requires completion of signature, printed name, title, telephone number, email address, company name, and address. Bidders must note any exceptions to the conflict of interest certification in a designated section and provide explanations for any identified conflicts.
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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 .