No Conflict of Interest (50).pdf
PDF 77 KB Posted
- Solicitation number
- PE-64800-NONST-2027-000000080
- Issued by
- Georgia
About this file
This is a No Conflict of Interest Certification form required by the Douglas County Board of Commissioners in Georgia for bidders responding to a janitorial services contract opportunity. The certification requires the undersigned bidder representative to certify that no members of the Douglas County Board of Commissioners, State of Georgia officials, relatives of such officials, or members of Congress have any direct or indirect financial interest in the bidder's organization or in any potential contract proceeds resulting from the bid submission. The form mandates that the certification be completed, signed, and submitted with the bid package. Any bidder making a false representation in this certification risks disqualification from contract award and future work opportunities with Douglas County.
The certification form requires the authorized bidder representative to provide their signature, printed name, title, telephone number, email address, company name, and company address. The form includes a section for bidders to document any exceptions to the conflict of interest certification with explanations. The undersigned certifies that they are legally authorized to make the representation and that the information provided is true to the best of their knowledge without deliberate omission of relevant facts.
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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 .