Statement_of_Affirmation_and_Intent.pdf
PDF 91 KB Posted
- Attached to
- Serving Counters FY2025 State and local contract opportunity
- Solicitation number
- 008-DW-1225
- Issued by
- Polk County, Florida
About this file
The document is a Statement of Affirmation and Intent for Project 011-DW-0325, a Commodity Processing opportunity with the School Board of Polk County, Florida, Purchasing Department. This form serves as a formal declaration by a potential vendor affirming the integrity and fairness of their proposal submission. The respondent certifies that the proposal is made without collusion, and that no board members, directors, or school board employees directly or indirectly own assets or will benefit from the proposal.
The form requires the respondent to confirm that no members of the company's ownership or management are currently applying for an employee position or seeking an elected position with the district. The vendor must also declare that they have carefully examined the scope of services, instructions, terms, and conditions of the Request for Proposal, and commits to meeting or exceeding the specified requirements and standards. The document includes space for the corporate name, address, authorized representative's signature, contact information, and requires notarization to validate the statement's authenticity.
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Text version
Statement of Affirmation and Intent
TO: The School Board of Polk County, Florida, Purchasing Department
PROJECT: 011-DW-0325, Commodity Processing
DATE:
The undersigned, hereinafter called the respondent, declares that this proposal is, in all respects, fair and without fraud that it is made without collusion with any other vendor or official of the School Board of Polk County (District). Neither the Affiant nor the above named entity has directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free competitive pricing in connection with the entity’s submittal for the above project.
The respondent certifies that no Board Member, Director, or any School Board Employee directly or indirectly owns assets or capital stock of the bidding entity, nor will directly or indirectly benefit by the profits or emoluments of this proposal.
The respondent certifies that no member of the entity’s ownership or management is presently applying for an employee position or actively seeking an elected position with the District. In the event that a conflict of interest is identified in the provision of services, the respondent agrees to immediately notify the District in writing.
The respondent further declares that he/she has carefully examined the scope of services, instructions, terms and conditions of this Request for Proposal and that respondent’s proposal is made according to the provisions of the RFP and that he/she will meet or exceed the scope of services, requirements, and standards contained in the Request for Proposal.
Corporate Name of Respondent (Typed) Address, City, Zip
Authorized Representative’s Signature Date Telephone Number
NOTARY PUBLIC:
State Of: County Of:
On this day of , 20 , before me appeared (name) sworn, did execute the foregoing document, and did state that he or she was properly authorized by (name of company)
, to execute the document and did so as his or her free act and deed.
Notary Public Signature:
Notary Name, Printed, Typed Or Stamped:
Commission Number: ________________ My Commission Expires:
Statement of Affirmation and Intent
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