18. CONFLICT OF INTEREST STATEMENT FOR HUD ASSISTED PROGRAMS
e following conflict of interest statement applies to both HUD assisted and City of Cape Coral SHIP programs.
Per U.S. Department of Housing and Urban Development (HUD) regulations 24 CFR §92.356 and 24 CFR §570.611, no employee,
agent, consultant, officer, or elected or appointed official of the recipient, or of any designated public agencies, or of subrecipients
having any functions or responsibilities related to activities assisted with Community Development Block Grant (CDBG), HOME
Investment Partnership Program (HOME) or Neighborhood Stabilization Program (NSP) funds may benefit from an assisted
activity. For purposes of the City of Cape Coral, this requirement also extends to immediate family members of individuals defined
above. Exceptions may be granted on a case by case basis by HUD upon written request of the recipient and after certain
disclosures are made public. Any conflicts noted will be investigated and resolved in accordance with HUD regulations.
_______I hereby certify that I do not have (nor does anyone in my immediate family have) any relations to or business
with any employee, agent, consultant, officer, or elected or appointed official of the City of Cape Coral or the organization
which is providing the assistance I am receiving.
_______I hereby certify that I do (or someone in my immediate family does) have relations to or business with an
employee, agent, consultant, officer, or elected or appointed official of the City of Cape Coral or the organization which is
providing the assistance I am receiving. Please list the name(s) of the person(s) involved in the potential conflict of interest
and please state the nature of your relationship and/or business interest with the person(s).
Further information will be required, and a separate meeting will be set up to discuss the disclosure of any potential conflicts of
plicant's Name (please print or type): ___________________________________________________________________
pplicant's Name (please print or type): _________________________________________________________________
plicant's Signature ______________________________________________________ Date _____________________
pplicant's Signature ___________________________________________________ Date_______________________