RFP 25-03_Attachment C.pdf
PDF 147 KB Posted
- Attached to
- Low-Code Application Development Services
- Solicitation number
- RFP-15318
- Issued by
- Polk County, Florida
About this file
This is a Vendor Conflicts of Interest Attestation form required for RFP 25-03 Low-Code Application Development Services issued by the Florida Department of Citrus (FDOC). The attestation requires the authorized representative of the responding vendor to declare under oath that all conflicts of interest involving FDOC employees have been disclosed, including any current FDOC employees on the vendor's staff and any employees who own five percent (5%) or more interest in the respondent or its affiliates. The form mandates that vendors certify their officers, directors, employees, and other agents will not create conflicts that would adversely impact performance of the required services. The attestation includes a table for detailed employee disclosure listing full legal names, position titles, disclosed positions held or ownership percentages, and signature and date fields. This document is subject to Chapter 112, Florida Statutes, and must be completed and submitted as part of the vendor's proposal response.
The attestation form itself contains no pricing information, set-asides, incumbent vendor details, or funding requirements, as it serves solely as a compliance and disclosure document. However, the related RFP establishes a total initial development budget of $200,000 for solution design, configuration, development, testing, and deployment, with an additional $50,000 for creating a Data Warehouse in Azure Synapse and integrating interfaces. The contract term runs from May 20, 2026, through June 30, 2027, with potential renewals extending three additional one-year periods subject to Florida Citrus Commission approval. Proposals are due April 21, 2026, at 1:00 PM ET in Bartow, Florida, with an anticipated Intent to Award on or about May 12, 2026. The RFP allocates five points for small business participation as an incentive within the broader scoring framework, and all vendors must be registered with MyFloridaMarketPlace and comply with Florida statutory requirements including E-Verify verification and drug-free workplace attestations.
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Text version
RFP 25-03
Low-Code Application Development Services
Attachment C: Vendor Conflicts of Interest Attestation 1 of 1
Attachment C: Vendor Conflicts of Interest Attestation
This solicitation is subject to Chapter 112, Florida Statutes. Respondents shall indicate whether or not any conflict exists regarding any Florida Department of Citrus employee.
I, _____________________________________ am the ________________________________ of
(Authorized Representative’s Name) (Title)
_______________________________________, (the “Vendor”), and am authorized to represent and
(Vendor’s Legal Name) contractually bind Vendor. Having been duly sworn, I do hereby attest, to the best of my knowledge and belief, the following:
• Vendor has disclosed all officers, directors, employees, other agents that are presently an employee of the Florida Department of Citrus; and
• Vendor has disclosed all employees that own, directly, or indirectly, an interest of five percent
(5%) or more in the respondent, or its affiliates; and
• Vendor’s officers, directors, employees, or other agents will not create a conflict in any manner or degree that will adversely impact the performance of the services required to be performed under the Contract.
Employee Disclosure:
Full Legal Name Position Title Disclosed Position Held or % of Ownership
Signature
Date
File details come from the government source that posted it. Updated .