1. ATTESTATION OF NO CONFLICT OF INTEREST

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

   

 

Back to top