DOUGLAS COUNTY JANITORIAL SERVICES-VARIOUS LOCATIONS

The Douglas County Board of Commissioners (Board) is requesting proposals for services of a qualified janitorial service company with verifiable experience to provide janitorial services at various County owned locations. This contract will be a one-year term that may be extended for up to four (4) additional one-year terms.

NO CONFLICT OF INTEREST
Except as may be identified and explained below, the undersigned hereby certifies that: (a) no
member of the Board of Commissioners, elected, appointed, and employee of the Douglas County;
(b) no elected, appointed, and employed official or employee of the State of Georgia and of a
governing body, instrumentality, or political subdivision; (c) no relative of any persons described
above; (d) no member of and delegate to the Congress of the United States has an interest
whatsoever (regardless of how indirect and how remote that interest may be) in bidder’s
organization and in the proceeds of a Contract and agreement which might be made between bidder
and the Douglas County Board of Commissioners as a result of the, quote, or qualification statement
accompanied by this certification.
The undersigned certifies that he/she is legally authorized by the bidder to make the above
representation, and that the representation is true to the best of his/her knowledge and belief and
without deliberate omission of any inquiry which would to the best of his/her belief tend to change
the above representation. The undersigned understands that any representation made knowing it
to be false may disqualify the bidder from being awarded the Contract and future work by Douglas
County Board of Commissioners.
NOTE: THIS CERTIFICATION MUST BE SIGNED AND SUBMITTED WITH THIS BID.
EXCEPTIONS: (Please explain)
Signature:
Print Name:
Title: Telephone #:
Email:
Name of Company:
Address: