Common use of ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED Clause in Contracts

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 68 contracts

Samples: Term Contract, Term Contract, Term Contract

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ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 59 contracts

Samples: Term Contract, Term Contract, Term Contract

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The : I certify that the foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.xin the year . xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type (Notary Seal) Signature of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public Notary Public for the State of My Commission Expires: (Printed, typed Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or stamped commissioned name veracity of Notary Public) the information provided herein. FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 49 contracts

Samples: Number 4, Term Contract, Term Contract

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Quoter Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 49 contracts

Samples: ftp.orangecountyfl.net, ftp.orangecountyfl.net, apps.ocfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 20 contracts

Samples: Procurement Division, ftp.orangecountyfl.net, Term Contract

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 17 contracts

Samples: apps.ocfl.net, www.leegov.com, apps.ocfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Proposer Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The : I certify that the foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.xin the year . xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type (Notary Seal) Signature of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public Notary Public for the State of My Commission Expires: (Printed, typed Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or stamped commissioned name veracity of Notary Public) the information provided herein. FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidderproposer, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 16 contracts

Samples: Contract # Y23, Contract # Y23 1080b, Contract # Y23

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The : I certify that the foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.xin the year . xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type (Notary Seal) Signature of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public Notary Public for the State of My Commission Expires: (Printed, typed Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or stamped commissioned name veracity of Notary Public) the information provided herein. FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 16 contracts

Samples: apps.ocfl.net, ftp.orangecountyfl.net, Employee Assistance Program

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Quoter Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC. In particular, the applicant needs to disclose whether any of the following relationships exist: (1) the applicant is a business associate of the Mayor or any member of the BCC; (2) any person involved with the approval of the item has a beneficial interest in the outcome of the matter and is a business associate of the Mayor or any member of the BCC; (3) the applicant is a relative of the Mayor or any member of the BCC; or (4) the Mayor or any member of the BCC is an employee of the applicant. (See Section 2-454, Orange County Code.) HOW ARE THE KEY RELEVANT TERMS DEFINED? Applicant means, for purposes of a development-related project, the owner, and, if applicable, the contract purchaser or owner’s authorized agent. Applicant means, for purposes of a procurement item, the bidder, offeror, quoter, respondent, and, if applicable, the authorized agent of the bidder, offeror, quoter, or respondent. Business associate means any person or entity engaged in or carrying on a business enterprise with a public officer, public employee, or candidate as a partner, joint venture, corporate shareholder where the shares of such corporation are not listed on any national or regional stock exchange, or co-owner of property. In addition, the term includes any person or entity engaged in or carrying on a business enterprise, or otherwise engaging in common investment, with a public officer, public employee, or candidate as a partner, member, shareholder, owner, co-owner, joint venture partner, or other investor, whether directly or indirectly, whether through a Business Entity or through interlocking Parent Entities, Subsidiary Entities, or other business or investment scheme, structure, or venture of any nature. (See Section 112.312(4), Florida Statutes, and Section 2-452(b), Orange County Code.)

Appears in 5 contracts

Samples: Great Oaks Village Pool Maintenance, ftp.orangecountyfl.net, ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Quoter Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,x.x. xxxxxxxe.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 4 contracts

Samples: ftp.orangecountyfl.net, ftp.orangecountyfl.net, ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 3 contracts

Samples: ftp.orangecountyfl.net, ftp.orangecountyfl.net, ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxx, e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 3 contracts

Samples: ftp.orangecountyfl.net, ftp.orangecountyfl.net, ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The : I certify that the foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.xin the year . xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type (Notary Seal) Signature of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public Notary Public for the State of My Commission Expires: (Printed, typed Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or stamped commissioned name veracity of Notary Public) the information provided herein. FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC. In particular, the applicant needs to disclose whether any of the following relationships exist: (1) the applicant is a business associate of the Mayor or any member of the BCC; (2) any person involved with the approval of the item has a beneficial interest in the outcome of the matter and is a business associate of the Mayor or any member of the BCC; (3) the applicant is a relative of the Mayor or any member of the BCC; or (4) the Mayor or any member of the BCC is an employee of the applicant. (See Section 2-454, Orange County Code.) HOW ARE THE KEY RELEVANT TERMS DEFINED? Applicant means, for purposes of a development-related project, the owner, and, if applicable, the contract purchaser or owner’s authorized agent. Applicant means, for purposes of a procurement item, the bidder, offeror, quoter, respondent, and, if applicable, the authorized agent of the bidder, offeror, quoter, or respondent. Business associate means any person or entity engaged in or carrying on a business enterprise with a public officer, public employee, or candidate as a partner, joint venture, corporate shareholder where the shares of such corporation are not listed on any national or regional stock exchange, or co-owner of property. In addition, the term includes any person or entity engaged in or carrying on a business enterprise, or otherwise engaging in common investment, with a public officer, public employee, or candidate as a partner, member, shareholder, owner, co-owner, joint venture partner, or other investor, whether directly or indirectly, whether through a Business Entity or through interlocking Parent Entities, Subsidiary Entities, or other business or investment scheme, structure, or venture of any nature. (See Section 112.312(4), Florida Statutes, and Section 2-452(b), Orange County Code.)

Appears in 2 contracts

Samples: ftp.orangecountyfl.net, ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- above-referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: [NAME OF PARTY ON BEHALF OF . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 1 contract

Samples: ftp.orangecountyfl.net

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ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. 12/13/2022 Signature of Bidder Date Printed Name and Title of Person completing this form: Xxxxxxxx Xxxxxxxxx Director of Business Development STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 1 contract

Samples: ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The : I certify that the foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.xin the year . xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type Signature of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or stamped commissioned name veracity of Notary Public) the information provided herein. FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 1 contract

Samples: Consulting Services

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Proposer Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The : I certify that the foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 by . He/she is personally known to me or has produced as identification and did/did not take an oath. Witness my hand and official seal in the county and state stated above on the day of , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.xin the year . xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type Signature of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public (Notary Seal) Notary Public for the State of My Commission Expires: (Printed, typed Staff signature and date of receipt of form Staff reviews as to form and does not attest to the accuracy or stamped commissioned name veracity of Notary Public) the information provided herein. FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidderproposer, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 1 contract

Samples: Term Contract

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Quoter Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: :_ . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 1 contract

Samples: ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) ) ss: ss:‌ COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxx, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. STAT.‌ §117.05] Notary Public Public‌‌ My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) Public)‌ FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE THE‌ RELATIONSHIP DISCLOSURE FORM FORM‌ Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? FORM?‌ The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 1 contract

Samples: apps.ocfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. 12/13/2022 Signature of Bidder Date Printed Name and Title of Person completing this form: Xxxxxxxx Xxxxxxxxx Director of Business Development STATE OF FLORIDA ) ) ss: COUNTY OF Orange ) The foregoing instrument was acknowledged before me by means of physical presence, or ☐X online notarization, this _13 day of December , 20 2022, by Xxxxxxxx Xxxxxxxxx [NAME OF PERSON], as Officer [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for Unique Designs Professional Serv [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐X Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] ______________ _ Notary Public My Commission Expires: 05/29/2024 Xxxxx X. Xxxxxxxx (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.Part III

Appears in 1 contract

Samples: ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form is true and correct based on my knowledge and belief. If any of this information changes, I further acknowledge and agree to amend this relationship disclosure form prior to any meeting at which the above- referenced project is scheduled to be heard. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Signature of Bidder Quoter Date Printed Name and Title of Person completing this form: STATE OF FLORIDA ) COUNTY OF ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. Personally Known; OR Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 1 contract

Samples: ftp.orangecountyfl.net

ORIGINAL SIGNATURE AND NOTARIZATION REQUIRED. I hereby certify that information provided in this relationship disclosure form specific project expenditure report is true and correct based on my knowledge and belief. If I acknowledge and agree to comply with the requirement of section 2-354, of the Orange County code, to amend this specific project expenditure report for any additional expenditure(s) incurred relating to this project prior to the scheduled Board of this information changes, County Commissioner meeting. I further acknowledge and agree that failure to amend this relationship disclosure form prior comply with these requirements to file the specific expenditure report and all associated amendments may result in the delay of approval by the Board of County Commissioners for my project or item, any meeting at associated costs for which the above- referenced project is scheduled to I shall be heardheld responsible. In accordance with s. 837.06, Florida Statutes, I understand and acknowledge that whoever knowingly makes a false statement in writing with the intent to mislead a public servant in the performance of his or her official duty shall be guilty of a misdemeanor in the second degree, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes. Date: Signature of Bidder Date Printed Name and Title of Person completing this form⌂ Principal or ⌂ Principal’s Authorized Agent (check appropriate box) PRINT NAME AND TITLE: STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of physical presence, or online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… x.x. xxxxxxxe.g. officer, trustee, etc.)] for INSTRUMENT WAS EXECUTED]. ☐ Personally Known; OR ☐ Produced Identification. Type of identification produced: [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT THE RELATIONSHIP DISCLOSURE FORM Updated 6-28-11 WHAT IS THE RELATIONSHIP DISCLOSURE FORM? The Relationship Disclosure Form (form OC CE 2D and form OC CE 2P) is a form created pursuant to the County’s Local Code of Ethics, codified at Article XIII of Chapter 2 of the Orange County Code, to ensure that all development-related items and procurement items presented to or filed with the County include information as to the relationship, if any, between the applicant and the County Mayor or any member of the Board of County Commissioners (BCC). The form will be a part of the backup information for the applicant’s item. WHY ARE THERE TWO RELATIONSHIP DISCLOSURE FORMS? Form OC CE 2D is used only for development-related items, and form OC CE 2P is used only for procurement-related items. The applicant needs to complete and file the form that is applicable to his/her case. WHO NEEDS TO FILE THE RELATIONSHIP DISCLOSURE FORM? Form OC CE 2D should be completed and filed by the owner of record, contract purchaser, or authorized agent. Form OC CE 2P should be completed and filed by the bidder, offeror, quoter, or respondent, and, if applicable, their authorized agent. In all cases, the person completing the form must sign the form and warrant that the information provided on the form is true and correct. WHAT INFORMATION NEEDS TO BE DISCLOSED ON THE RELATIONSHIP DISCLOSURE FORM? The relationship disclosure form needs to disclose pertinent background information about the applicant and the relationship, if any, between, on the one hand, the applicant and, if applicable, any person involved with the item, and on the other hand, the Mayor or any member of the BCC.

Appears in 1 contract

Samples: Construction Term Contract

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