Statement_of_Affirmation_and_Intent.pdf
PDF 91 KB Posted
- Attached to
- Commodity Processing Foods
- Solicitation number
- 011-DW-0325
- Issued by
- Polk County, Florida
About this file
The document is a Statement of Affirmation and Intent form for the School Board of Polk County, Florida, Purchasing Department, specifically for Project 011-DW-0325 related to Commodity Processing. The form is designed to ensure fair and competitive bidding practices, with the respondent declaring that their proposal is made without collusion and meets all requirements of the Request for Proposal (RFP).
The form requires the respondent to certify several key ethical and procedural commitments, including: no direct or indirect ownership of assets by Board Members or employees, no conflicts of interest in applying for positions, and a thorough examination of the RFP's scope of services. The respondent must provide their corporate name, address, authorized representative's signature, and have the document notarized, affirming their commitment to transparency and compliance with the district's procurement guidelines for the commodity processing project.
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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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