No Conflict of Interest (53).pdf
PDF 77 KB Posted
- Attached to
- Public Health Building Renovation
- Solicitation number
- PE-64800-NONST-2026-000000083
- Issued by
- Douglas County, Georgia
About this file
This is a No Conflict of Interest certification form required by Douglas County, Georgia for bidders responding to the Public Health Building Renovation project. The certification requires bidders to attest that no members of the Douglas County Board of Commissioners, elected or appointed officials, employees of Douglas County or the State of Georgia, relatives of such persons, or members of Congress have any direct or indirect interest in the bidder's organization or in the proceeds of any contract resulting from the bid submission. The undersigned representative must confirm they are legally authorized to make this representation and certify that all statements are true and complete to the best of their knowledge. The form requires the bidder's signature, printed name, title, telephone number, email address, company name, and address.
Any conflicts of interest must be identified and explained in the exceptions section of the form. Bidders are advised that any false representation may result in disqualification from contract award and future work with Douglas County Board of Commissioners. This certification is a mandatory submission requirement and must accompany the bid submission. The certification applies to the design, permitting, site preparation, expansion, and remodel of the Douglas County Public Health Center located at 6770 Selman Drive, Douglasville, Georgia, which will be funded through a combination of Cobb & Douglas Public Health reserve funds and Douglas County General Fund appropriations.
View the file
Other files
Show all 15
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .