The Financial Disclosures and Conflicts of Interest form (“form”) must be accurately completed and submitted by the vendor, parent entity(ies), and subcontractors. There are nine steps to this form and each must be completed as instructed in the step heading and within the step. A bid, offer, or proposal that does not include this form shall be considered non-responsive. The Agency/University will consider this form when evaluating the bid, offer, or proposal or awarding the contract. The requirement of disclosure of financial interests and conflicts of interest is a continuing obligation. If circumstances change and the disclosure is no longer accurate, then disclosing entities must provide an updated form. Separate forms are required for the vendor, parent entity(ies), and subcontractors. This disclosure is submitted for: Vendor Vendor’s Parent Entity(ies) (100% ownership) Subcontractor(s) >$50,000 Subcontractor’s Parent Entity(ies) (100% ownership) > $50,000 Project Name Illinois Procurement Bulletin Number Contract Number Vendor Name Doing Business As (DBA) Disclosing Entity Disclosing Entity’s Parent Entity Subcontractor Instrument of Ownership or If you selected Other, please describe: Beneficial Interest EP 1
The Financial Disclosures and Conflicts of Interest form (“form”) must be accurately completed and submitted by the vendor, parent entity(ies), and subcontractors. There are nine steps to this form and each must be completed as instructed in the step heading and within the step. A bid, offer, or proposal that does not include this form shall be considered non-responsive. The Agency/University will consider this form when evaluating the bid, offer, or proposal or awarding the contract. The requirement of disclosure of financial interests and conflicts of interest is a continuing obligation. If circumstances change and the disclosure is no longer accurate, then disclosing entities must provide an updated form. Separate forms are required for the vendor, parent entity(ies), and subcontractors. This disclosure is submitted for: Vendor Vendor’s Parent Entity(ies) (100% ownership) Subcontractor(s) >$50,000 Subcontractor’s Parent Entity(ies) (100% ownership) > $50,000 Project Name Illinois Procurement Bulletin Number Contract Number Vendor Name Doing Business As (DBA) Disclosing Entity Disclosing Entity’s Parent Entity Subcontractor Instrument of Ownership or Beneficial Interest If you selected Other, please describe: EP 1
Financial%20Disclosures%20and%20Conflicts%20of%20Interests%20V.13.5.docx