RFP 2026-01 Information Technology Services and Management Amendment No. 2

AUTHORIZED REPRESENTATIVE DECLARATIONS FORM
_____________________________ (Name of Respondent Representative) for
____________________________________ (Respondent), being duly sworn, deposes and says that:
1. The Signatory is an "Authorized Agent" who can bind the above-listed entity to all terms and conditions
of the Request for Proposals/Services and the subsequent Proposal Submittal.
2. The Signatory is fully informed respecting the preparation and contents of the attached Proposal and
of all Forms, Affidavits and documents submitted in support of such Proposal;
3. The Signatory declares no portion of the sum that Respondent may receive as a result of this
Solicitation will be paid to any employees of the Palm Beach Metropolitan Planning Organization
(MPO), its elected officials, and/or its consultants, as a commission, kickback, reward or gift,
directly or indirectly by me or any member of my firm or by an officer of the corporation.
4. The Signatory declares that the Respondent represented herein shall not discriminate against any
person in its operations, activities or delivery of services under any agreement it enters into with the
TPA. The same shall affirmatively comply with all applicable provisions of federal, state and local
equal employment laws and shall not engage in or commit any discriminatory practice against any
person based on race, age, religion, color, gender, sexual orientation, national origin, marital status,
physical or mental disability, political affiliation or any other factor which cannot be lawfully used as a
basis for service delivery.
5. The Signatory has attached, if applicable, a list of and description of any relationships, professional,
financial or otherwise that Respondent may have with the MPO, its elected or appointed officials, its
employees or agents or any of its agencies or component units for the past two (2) years.
Additionally, the Respondent agrees and understands that Respondent shall give the MPO written
notice of any other relationships professional, financial or otherwise that Respondent enters into with
the MPO its elected or appointed officials, its employees or agents or any of its agencies or
component units during the period of this Agreement.
6. The Submittal is provided as a genuine offer without prior understanding, agreement, or connection
with any corporation, firm, or person providing a Submittal for the same materials, services, and
supplies and is, in all respects, fair and without collusion or fraud.
7. The completed PRICING PROPOSAL is submitted as the current, accurate, complete, and all-
inclusive Total Pricing, including "out-of-pocket" expenses (if any), to provide the MPO with Services in
accordance with the Requirements/Services set forth in this RFP document.
8. Any hourly rates quoted in the attached Submittal are fair and proper and are not tainted by any
collusion, conspiracy, connivance, or unlawful agreement on the part of the Respondent or any other
of its agents, representatives, owners, employees or parties in interest, including this affiant.
9. All Forms, Affidavits and documents submitted in support of and included in this Proposal are true
and accurate;
10. No information that should have been included in such Forms, Affidavits and documents has been
omitted; and
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AUTHORIZED REPRESENTATIVE FORM - CONTINUED
12. No information that is included in such Forms, Affidavits or documents is false or misleading.
13. The Respondent has the financial stability to fully perform the terms and conditions as specified
herein and will provide financial information to document this upon request by the MPO at any time
during the solicitation process and in any form deemed necessary by the MPO.
14. Respondent and any sub-contractors or sub-consultants shall comply with Section 448.095, Fla. Stat.,
"Employment Eligibility," including registration and use of the E-Verify system to verify the work
authorization status of employees. Failure to comply with Section 448.095, Fla. Stat. shall result in
termination of the resulting Contract/Purchase Order, if awarded. Any challenge to termination under
this provision must be filed in the Circuit Court no later than 20 calendar days after the date of
termination. If the contract is terminated for a violation of the statute by the Contractor, the Contractor
may not be awarded a public contract for a period of 1 year after the date of termination.
15. The Respondent will register with the Florida Division of Corporations as either a Florida or foreign
corporation prior to the effective date of the contract with the MPO if it is the Awardee and is not
presently registered.
_________________________________
Signature
_________________________________ (CORPORATE SEAL)
Print Name
_________________________________
Title
_________________________________
Date
STATE OF FLORIDA )
COUNTY OF )
The foregoing instrument was acknowledged before me this ___ day of __________, 20__,
Personally known to me ______ OR
Has produced Identification _____, type of identification produced ___________________.
__________________________________________
Notary Public, State of Florida
__________________________________________
(Printed Name)
My commission expires:_______________________
IMPORTANT: FAILURE TO SUBMIT THIS PAGE, INCLUDING ALL REQUIRED INFORMATION AND
SIGNATURES, WILL BE CAUSE FOR THE PROPOSAL TO BE DEEMED "NON-RESPONSIVE" AND
WILL RESULT IN IMMEDIATE REJECTION OF THE ENTIRE PROPOSAL RESPONSE.
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