Statement_of_Affirmation_and_Intent.pdf
PDF 89 KB Posted
- Attached to
- Armored Car Services
- Solicitation number
- 001-MJ-0727
- Issued by
- Polk County, Florida
About this file
This is a Statement of Affirmation and Intent form for the School Board of Polk County, Florida, related to a competitive solicitation for armored car and secure courier services. The document serves as the respondent's certification that their proposal is submitted fairly and without fraud, collusion, or anti-competitive practices. Respondents must affirm that they have not entered into any agreements with other vendors or District officials that would restrain free competitive pricing, and that no Board members, Directors, or School Board employees directly or indirectly own assets in the bidding entity or will benefit from the proposal's profits. The form requires the respondent's corporate name, address, authorized representative signature, date, and telephone number, along with notarization by a public notary to validate the affiant's authority to execute the document on behalf of the company.
The statement additionally requires respondents to certify that no members of the entity's ownership or management are applying for employment or seeking elected positions with the District, and that any identified conflicts of interest will be immediately reported in writing to the District. Respondents must confirm they have thoroughly examined the scope of services, instructions, terms, and conditions of the solicitation and commit to meeting or exceeding all requirements and standards outlined. The form establishes the legal framework for competitive bidding integrity and ensures compliance with procurement regulations governing the District's armored car and secure courier services contract, which covers transportation of deposits, negotiable instruments, confidential financial materials, and other authorized items between District locations and financial institutions in support of finance and accounting operations.
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Text version
Statement of Affirmation and Intent
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, Florida (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 solicitation and that respondent’s proposal is made according to the provisions of the solicitation and that he/she will meet or exceed the scope of services, requirements, and standards contained in the solicitation.
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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