No Conflict of Interest (54).pdf
PDF 77 KB Posted
- Attached to
- Basketball Court Flooring Restoration
- Solicitation number
- PE-64800-NONST-2027-000000085
- 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 the Basketball Court Flooring Restoration project. The form mandates that bidders certify the absence of conflicts of interest involving members of the Douglas County Board of Commissioners, state and local officials, relatives of such officials, and members of Congress. Bidders must affirm that no such parties have any direct or indirect interest in the bidder's organization or in the potential contract proceeds resulting from the submission of a bid, quote, or qualification statement. The certification requires the signature of a legally authorized representative who attests to the truthfulness of the representation based on their knowledge and belief without deliberate omission of relevant information.
The form emphasizes that submission of this signed certification is mandatory with the bid submission and that any false representation may result in disqualification from contract award and future work with Douglas County. The certification provides space for exceptions to be documented with explanations, and requires the bidder to supply identifying information including signature, printed name, title, telephone number, email address, company name, and business address. This document serves as a compliance requirement ensuring ethical bidding practices and the integrity of the procurement process for the restoration work involving water mitigation, hardwood flooring repairs, and related improvements to the commercial athletic facility.
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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 .