Place on current Department Letterhead
ATTESTATION OF NO CONFLICT OF INTEREST
Individuals taking part in the development or selection of criteria for evaluation, the evaluation process and the award process shall attest in writing that they are independent of and have no conflict of interest in the entities evaluated and selected, in accordance with § 287.057(19), Florida Statutes.
The undersigned individual(s) hereby attest that he/she/they are independent of the procurement represented on Contract/Grant no. and that he/she/they have no conflict of or interest in, the entity evaluated and selected.
|
Contractor’s Name |
|
Address |
|
City, State & Zip Code |
____________________________ |
_____________ |
Contract Manager’s Signature |
Date |
____________________________ |
_____________ |
Contract Administrator’s Signature |
Date |
____________________________ |
_____________ |
Director’s Signature |
Date |