Invitation to Negotiate (ITN) - Florida State Board of Administration

Appendix III: Service Requirements -Affirmation StatementBy inclusion and execution of the statement provided herein, each Respondent shall certify that:The selection of the Respondent will not result in any current or potential conflict ofinterest with the SBA or any participating insurer. Alternately, should any potential orexisting conflict be known by the Respondent, the proposal shall specify the party withwhich the conflict exists or might arise, the nature of the conflict and whether theRespondent would step aside or resign from that engagement creating the conflict.The proposal is made without prior understanding, agreement, or connection with anycorporation, Respondent, or person submitting a proposal for the same services, and is inall respects fair and without collusion or fraud.The selection of the Respondent will not violate Section 215.684, Florida Statutes, whichprohibits the State from selecting certain providers that have been convicted of or entereda plea of nolo contendere to fraud within a period of two years of such conviction.The Respondent and the agents, officers, principals, and professional employees thereofhave not and will not participate in any communication prohibited in this ITN.The Respondent’s responses to the ITN are those of the Respondent and have not beencopied or obtained from any other Respondent responding to any other ITN orcompetitive proposal whether in Florida or elsewhere either in the past or present.If retained for both administrative and actuarial consulting services, the Respondent willmaintain independent actuaries pursuant to 215.555 (5)(a), Florida Statutes.The Respondent hereby agrees to abide by all conditions of this ITN for AdministrativeServices and/or Actuarial Consulting Services and certifies that all information providedin this response is true and correct, that I am authorized to sign this response for theRespondent and that the Respondent is in compliance with all requirements of this ITN,including but not limited to, requirements in this exhibit._________________________________________________Authorized Signature (Manual)_________________________________________________Name and Title (Typed)_________________________________________________Date (Typed)Appendix III 32