103D STANDARDS OF CONDUCT DECLARATION.pdf
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- Solicitation number
- B27000289
- Issued by
- Hawaii
About this file
This is a Standards of Conduct Declaration form (Form AG-010) required by the State of Hawaii for contractors entering into state contracts. The form serves as a sworn declaration under penalty of perjury, wherein the contractor certifies compliance with Hawaii Revised Statutes Chapter 84 (Code of Ethics). The contractor must declare that: (1) it is not a legislator or employee, nor does a legislator or employee hold a controlling interest in the business; (2) the contractor has not been personally represented or assisted by a former agency employee within the two years preceding the contract award who participated in the matter while employed; (3) no legislator or employee has been or will be compensated to represent the contractor in obtaining or performing the contract if such person was involved in its development or award; and (4) the contractor has not been represented on contract-related matters within the past twelve months by individuals who were recently employed by the contracting agency or served in the legislature while participating in related matters.
The declaration applies to the Judiciary's Second Circuit contract (IFB J27160) for maintenance, inspections, and diagnostics services for Air Conditioning and Ventilation Systems at Hoapili Hale. The State reserves the right to void any contract entered into in violation of Chapter 84 provisions and may recover any fees, compensation, gifts, or profits received as a result of ethics violations. If the contractor indicates it is a legislator or employee with a controlling interest and the contract value exceeds $10,000, the award must be made through competitive sealed bidding or sealed proposals under Hawaii Revised Statutes Section 103D-302 or 103D-303, or the agency must post a notice of intent to award and file it with the State Ethics Commission.
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Text version
Form AG-010 Rev 11/15/2005
STANDARDS OF CONDUCT DECLARATION
For the purposes of this declaration:
"Employee" means any nominated, appointed, or elected officer or employee of the State, including members of boards, commissions, and committees, and employees under contract to the State or of a constitutional convention, but excluding legislators, delegates to the constitutional convention, justices and judges.
"Controlling interest" means an interest in a business or other undertaking which is sufficient in fact to control, whether the interest is greater or less than fifty per cent.
On behalf of ___________________________________________________________, CONTRACTOR, the undersigned does declare, under penalty of perjury, as follows:
1. CONTRACTOR is* is not a legislator or an employee or a business in which a legislator or an employee has a controlling interest. (Section 84-15(a), HRS).
2. CONTRACTOR has not been represented or assisted personally in the matter by an individual who has been an employee of the agency awarding this Contract within the preceding two (2) years and who participated while so employed in the matter with which the Contract is directly concerned. (Section 84-15(b), HRS).
3. CONTRACTOR has not been assisted or represented by a legislator or employee for a fee or other compensation to obtain this Contract and will not be assisted or represented by a legislator or employee for a fee or other compensation in the performance of this Contract, if the legislator or employee had been involved in the development or award of the Contract. (Section 84-14(d), HRS).
4. CONTRACTOR has not been represented on matters related to this Contract, for a fee or other consideration by an individual who, within the past twelve (12) months, has been an agency employee, or in the case of the Legislature, a legislator, and participated while an employee or legislator on matters related to this Contract. (Sections 84-18(b) and (c), HRS).
CONTRACTOR understands that the Contract to which this document is attached is voidable on behalf of the State if this Contract was entered into in violation of any provision of chapter 84, Hawaii Revised Statutes, commonly referred to as the Code of Ethics, including the provisions which are the source of the declarations above. Additionally, any fee, compensation, gift, or profit received by any person as a result of a violation of the Code of Ethics may be recovered by the State.
Form AG-010 Rev 11/15/2005
CONTRACTOR
By ____________________________________________ (Signature)
Print Name:_____________________________________
Print Title:______________________________________
Name of Contractor:______________________________
Date:__________________________________________
*Reminder to Agency: If "is" block is checked and the Contract involves goods or services or construction of a value in excess of $10,000, the Contract must be awarded by competitive sealed bidding under section 103D-302, HRS, or a competitive sealed proposal under section 103D-303, HRS. Otherwise, the Agency may not award the Contract unless it posts a notice of its intent to award it and files a copy of the notice with the State Ethics Commission. (Section 84-15(a), HRS).
| Name of Contractor 1: |
| Name of Contractor 2: |
| Standards Print Name: |
| Standards Print Title: |
| Standards Date: |
| Standards Contractor Name: |
| Standards Check Box1: Off |
| Standards Check Box2: Off |
| Contractor Signature By: |
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